吲哚菁绿清除试验对原发性肝癌患者术前肝脏储备功能的评估价值

摘要/Abstract

摘要： 目的探讨吲哚菁绿（ICG）清除试验对原发性肝癌患者术前肝脏储备功能的评估价值。方法对71例肝癌患者和50名健康体检人员,用日本DDG-3300K分析仪及配套分析软件检测ICG15分钟清除率（ICGR15）,同时检测肝功能、血常规、腹部B超等,计算肝功能Child-Turcotte-Pugh（CTP）评分并分级。两组均值比较采用t检验,多组均值比较采用方差分析,相关分析采用线性相关分析或Spearman等级相关分析。结果肝癌患者的ICGR15为（18.7±4.3）%较正常对照组（4.7±1.2）%升高,（t=–22.39,P<0.05）。CTP分级越高,肝癌患者ICGR15越高,差异有统计学意义（F=51.43,P<0.05）,ICGR15与CTP分级呈正相关（r=0.722,P<0.05）,与肝血流量、血浆清除率呈负相关（r=–0.889、–0.753,P<0.05）。不同ICGR15的肝癌患者的PT、INR、ALT、AST、Alb、TBil差异有统计学意义（t=3.39、61.9、2.62、3.19、69.0、40.5,P<0.05）,ICGR15与PT、INR、AST、TBil呈正相关（r=0.665、0.527、0.316、0.721,P<0.05）,与白蛋白呈负相关（r=–0.507,P<0.05）,其中与PT、TBil相关性最强。结论 ICG清除试验能够较准确地动态反映肝脏储备功能,使用ICGR15评估肝脏储备功能优于CTP分级。

关键词: 原发性肝癌, 吲哚菁绿清除试验, 肝脏储备功能

Abstract: Objective To investigate the indocyanine green clearance test for preoperative liver reserve function of patients with primary liver cancer.Methods Fifty healthy people and 71 patients were enrolled as control group and study group,respectively.Indocyanine green clearance rate in 15 minutes（ICGR15）,hepatic function,blood routine test and abdominal ultrasound were measured in all patients,and the Child-Turcotte-Pugh （CTP）scores were calculated for classification.All data were analyzed by student＇s t-test,one-way analysis of variance and linear correlation analysis with SPSS 17.0.Results The levels of ICGR15 in patients with primary liver cancer（18.7±4.3）were higher than those in controls（4.7±1.2）（t=–22.39,P<0.05）.Moreover,levels of ICGR15 were positively correlated with the CTP score（r=0.722,P<0.05）,but negatively correlated with hepatic blood flow（r=–0.889,P<0.05）and plasma clearance rate（r=–0.753,P<0.05）.Comparisons in levels of prothrombin time（PT）,international normalized ratio（INR）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,albumin（Alb）and total bilirubin（TBil）among patients with different levels of ICGR15 showed statistically differences（t=3.39,61.9,2.62,3.19,69.0,40.5;P<0.05）.Meanwhile,levels of ICGR15 was positively correlated with the levels of PT,INR,AST and TBil（r=0.665,0.527,0.316,0.721;P<0.05）,but negatively correlated with the levels of Alb（r=–0.507,P<0.05）.Furthermore,ICGR15 showed strongest correlation with the levels of PLT and TBil.Conclusion The indocyanine green clearance test could dynamically reflect liver reserve function,which is more accurately than CTP classification.

Key words: Primary liver cancer, Indocyanine green clearance test, Liver reserve function

黄文琪, 许金超, 闵峰, 吴卫兵, 范荣华, 张丽. 吲哚菁绿清除试验对原发性肝癌患者术前肝脏储备功能的评估价值[J]. 肝脏, 2017, 22(1): 6-.

HUANG Wen-qi, XU Jin-chao, MIN Feng, WU Wei-bing, FAN Rong-hua, ZHANG Li. Assessment value of indocyanine green clearance test for preoperative liver reserve function of patients with primary liver cancer[J]. Chinese Hepatolgy, 2017, 22(1): 6-.

参考文献

[1] 中华人民共和国卫生部.原发性肝癌诊疗规范2011年版.临床肿瘤学杂志,2011,16:929-946.
[2] Durand F,Valla D.Assessment of the prognosis of cirrhosis:Child-Pugh versus MELD.J Hepatol,2005,42 Suppl(1):S100-107.
[3] 余永红,黄家丽,李建生,等.半肝切除手术中应用DDG检测肝储备功能的护理配合.实用肝脏病杂志,2009,12:437-438.
[4] 郑盛,殷芳,刘海,等.四种评分系统预测慢性重型肝炎预后的价值比较.实用肝脏病杂志,2011,14:119-121.
[5] Gao J,Zhu JY,Leng XS,et al.Clinical evaluation of liver reserve function pre-operation for the 125 primary liver carcinoma with cirrhosis patients in single center.J Hepatobiliary Surg,2011,19:15-17.
[6] 马春华,陈煜,陈成伟,等.吲哚菁绿清除试验对急性/慢加急性肝衰竭患者预后的评价.临床肝胆病杂志,2012,29:372-375.
[7] Schneider PD.Preoperative assessment of liver function.Surg Clin North Am,2004,84:355-373.
[8] Cucchetti A,Ercolani G,Vivarelli M,et al.Impact of model for end-stage liver disease (MELD)score on prognosis after hepatectomy for hepatocellular carcinoma on cirrhosis.Liver Transpl,2006,12:966-971.
[9] Cescon M,Cucchetti A,Grazi GL,et al.Indication of the extent ofhepatectomy for hepatocellular carcinoma on cirrhosis by a simple algorithm based on preoperative variables.Arch Surg,2009,144:57-63.
[10] Kamath PS,Kim WR.The model for end-stage liver disease(MELD).Hepatology,2007,45:797-805.
[11] Pasqualetti P,Di Lauro G,Festuccia V,et al.Prognostic value of Pugh′s modification of Child-Turcotte classification in patients with cirrhosis of the liver.Panminerva Med,1992,34:65-68.
[12] Seyama Y,Kokudo N.Assessment of liver function for safe hepatic resection.Hepatol Res,2009,39:107-116.
[13] Gallegos-Orozco JF,Vargas HE .Liver transplantation :from Child to MELD .Med Clin North Am,2009,93:931-950.
[14] 李灵敏,肖天利,陈文生.MELD与CTP评分系统对TIPS术后患者预后的评价作用.第三军医大学学报,2009,31:733-736.
[15] Sheng QS,Lang R,He Q,et al.Indocyanine green clearance test and model for end—stage liver disease score of patients with liver cirrhosis.Hepatobiliary Pancreat Dis Int,2009,8:46-49.
[16] 杜正贵,李波,冯曦,等.吲哚氰绿排泄试验及标准余肝体积与肝癌切除术后肝功能不全的相关性研究.中华外科杂志,2010,48:189-192.