吲哚菁绿排泄试验在肝硬化门脉高压手术中的应用

Application of Indocyanine Green Clearance Test in Portal Hypertension of Liver Dysfunction

目的探讨吲哚菁绿(indocyanine green,ICG)排泄试验在肝硬化门脉高压患者手术中的应用价值。方法回顾性分析2012-04/2016-06月作者医院收治的124例肝硬化门脉高压手术患者的临床资料。根据术后肝功能恢复情况分为肝功能不全组(n=26)和肝功能代偿良好组(n=98)。根据术前吲哚菁绿15分钟滞留率(indocyanine green retention rate at 15minute,ICGR_(15))水平将患者分为ICGR_(15)≤10%(n=40)、10%<ICGR_(15)<30%(n=62)、ICGR_(15)≥30%(n=22)3组。比较各组临床指标的差异,用受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under the curve,AUC)衡量ICGR_(15),预测肝硬化门脉高压患者术后肝功能不全的准确率。结果 124例肝硬化门脉高压患者发生术后肝功能不全26例,发生率为20.97%,其中1例患者死于肝功能衰竭,死亡率为0.81%。术后肝功能不全组患者的术前ICGR_(15)显著高于肝功能代偿良好组,组间比较差异具有统计学意义(P<0.05)。ICGR_(15)预测患者术后肝功能不全的ROC曲线AUC为0.800,其最佳临界值为18.6,相应的灵敏度为84.6%,特异度为67.3%。ICGR_(15)≤10%、10%<ICGR_(15)<30%、ICGR_(15)≥30%3组术前不同ICGR_(15)水平患者的术后肝功能不全发生率分别为5.00%(2/40)、22.58%(14/62)、45.45%(10/22),组间比较差异具有统计学意义(P<0.05)。结论肝硬化门脉高压患者术后肝功能恢复与患者肝脏储备功能有关。ICGR_(15)是预测肝硬化门脉高压患者术后肝功能不全的良好指标。ICGR_(15)≥30%时行门脉高压手术更有可能发生术后肝功能不全。

Objective To assess the application value of indocyanine green （ICG） clearance test in cirrhosis and portal hypertension of liver dysfunction. Methods The clinical data of 124 patients with cirrhosis and portal hypertension in author ＇s hospital from April 2012 to June 2016 were collected and retrospectively analyzed. According to postoperative recovery of liver function, all patients were divided into liver dysfunction group （n = 26） and better liver function group （n = 98）. Based on preoperative indocyanine green retention rate at 15 minute （ICGR15） ,patients were divided into 3 group, including ICGR15≤10%（n = 40）, 10%〈ICGR15〈30≤ （n = 62） and ICGR15≥30% （n = 22）. Clinical data were compared among three groups. The area under the curve （AUC） of receiver operating characteristic （ROC） was used to measure the accuracy of ICGR15 in predicting postoperative liver dysfunction in patients with cirrhosis and portal hypertension. Results Liver dysfunction occurred in 26 patients of 124 cirrhosis and portal hypertension patients,about 20. 97%,and 1 patient died of liver failure,about 0. 81 %. The preoperative ICGR15 levels in the liver dysfunction group were higher than these in the better liver function group （P〈0.05）. The AUC of ICGR15 in predicting postoperative liver dysfunction was 0. 800 and the critical value was 18. 6, with 84. 6% sensitivity and 67.3 % specificity. The incidences of postoperative liver dysfunction were 5.00%（2/40） ,22. 58% （14/62）, 45.45%（10/22） in the group with ICGR15≤10%,10% 〈ICGR15 〈30% and ICGR15≥30% ,respectively. There were significantly differences in the incidences of postoperative liver dysfunc- tion among three groups （P〈0. 05）. Conclusion Postoperative liver function recovery in cirrhotic patients with portal hy- pertension is associated with liver reserve function. ICGRIs is a good predictive indicator of postoperative liver dysfunction in patients with cirrhosis and portal hypertension. Patients with ICGR15≥30% are more likely to occur postoperative liver dysfunction.