吲哚菁绿清除率对肝切除术患者肝功能的预测价值

摘要/Abstract

摘要： 目的通过对吲哚菁绿(ICG)清除率的测定来预测肝切除术患者肝功能的状态。方法纳入2016年9月至2019年9月入院收治施行解剖性肝切除术患者68例。所有患者均接受ICG清除试验并且术后病理诊断为原发性肝细胞癌。比较采用t检验;Pearson相关性分析探讨ICG15min潴留率(ICG-R15)与观察资料的相关性;采用Logistic回归分析引起肝功能不全的独立危险因素。结果 68例患者中肝功能正常52例,肝功能不全16例。两组患者的年龄、血小板、总胆红素、ALT、AST、前白蛋白、凝血酶原国际标准化比率、手术时间、术前ICG-R15比较差异均无统计学意义(P>0.05),而术中出血量、术中ICG-R15及肝切除量之间差异有统计学意义(P<0.05)。患者术中ICG-R15为(14.5±7.0)%,较术前的(6.8±5.5)%,显著上升(P<0.05);Pearson相关性分析提示术中ICG-R15与术前ICG-R15、术中出血量及肝切除量之间均存在显著相关(相关性系数分别为0.49、0.72和0.60,均P<0.05)。将术中ICG-R15、术前ICG-R15、术中出血量及肝切除量纳入Logistic回归模型,结果提示术中ICG-R15肝切除量是解剖性肝切除术患者发生肝功能不全的独立危险因素(均P<0.05)。结论 ICG清除率的测定有助于为解剖性肝切除术患者肝功能状态提供参考,术中ICG-R15是患者发生肝功能不全的独立危险因素。

关键词: 解剖性肝切除术, 吲哚菁绿清除率, 肝功能不全, Logistic回归模型

Abstract: Objective To predict the liver function after anatomical hepatectomy by measuring the clearance rate of indocyanine green (ICG).Methods From September 2016 to September 2019, 68 patients who underwent anatomical hepatectomy, including 51 males and 17 females, with an average age of (49.8±10.2) years, were enrolled in our study. All patients underwent ICG clearance test and were pathologically diagnosed as primary hepatocellular carcinoma. The measurement data were expressed as (±s) and analyzed by t-test. Pearson correlation analysis was used to investigate the correlation between ICG retention rate at 15 minutes (ICG-R15) and observational data. Logistic regression model was used to identify the independent risk factors for postoperative liver insufficiency. Results The patients were divided into 2 groups: normal liver function group (n = 52) and liver insufficiency group (n = 16). There was no significant difference in age, platelet, total bilirubin, alanine aminotransferase, aspartate aminotransferase, prealbumin, prothrombin time international normalized ratio, operation time and preoperative ICG-R15 between the 2 groups. There were significant differences in intraoperative blood loss, intraoperative ICG-R15 and resected liver volume (P<0.05). Intraoperative ICG-R15 was significantly higher than preoperative ICG-R15 [(14.5±7.0)%, (6.8±5.5)%, P<0.05]. Pearson correlation analysis suggested that preoperative ICG-R15, intraoperative bleeding and resected liver volume had significant correlation with intraoperative ICG-R15 (correlation coefficients were 0.49, 0.72 and 0.60, respectively, P<0.05). Logistic regression analysis suggested that intraoperative ICG-R15 and resected liver volume were independent risk factors for liver insufficiency after anatomical hepatectomy, while preoperative ICG-R15 and intraoperative bleeding were not.Conclusion ICG clearance rate measurement is helpful to predict the state of liver function after anatomical hepatectomy. Intraoperative ICG-R15 is an independent risk factor for postoperative liver insufficiency.

Key words: Anatomical hepatectomy, Indocyanine green clearance rate, Hepatic insufficiency, Logistic regression model

戴兵, 张林娇, 刘驰, 杨启, 吕新远, 王磊. 吲哚菁绿清除率对肝切除术患者肝功能的预测价值[J]. 肝脏, 2020, 25(5): 480-482.

DAI Bing, ZHANG Lin-jiao, LIU Chi, YANG Qi, LV Xin-yuan, WANG Lei. The value of indocyanine green clearance measurement in predicting liver function in patients undergoing anatomical hepatectomy[J]. Chinese Hepatolgy, 2020, 25(5): 480-482.

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