乙型肝炎肝硬化患者的吲哚箐绿清除试验与Child-Pugh分级相关性的研究
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摘要
目的对吲哚箐绿(ICG)清除试验与Child-Pugh评分进行对比研究,评估临床应用价值,探讨两者的相关性。方法选择2016年1月至2017年4月在青海省第四人民医院肝病科住院的101例患者,其中慢性乙型肝炎(CHB)41例,乙型肝炎肝硬化60例(Child-Pugh A级27例,Child-Pugh B级33例)。比较各组的ICG清除试验指标[ICG血浆清除率值(K值)、有效肝血流量(EHBF)、ICG 15 min滞留率(ICG R15)]、Child-Pugh分级、肝脏血清生物化学指标[总胆红素(TBil)、白蛋白(Alb)、凝血酶原时间(PT)],并分析ICG清除试验与Child-Pugh分级的相关性。结果 CHB组的ICG R15、K值、PT、Alb与肝硬化组比较,差异均有统计学意义(P均<0.05);两组的EHBF、TBil比较,差异无统计学意义;肝硬化组中,Child-Pugh A级组与Child-Pugh B级组比较显示,随着Child-Pugh分级升高,ICG R15、PT、TBil水平升高,而K值、EHBF、Alb水平下降,差异均有统计学意义(P均<0.05);ICG R15的受试者工作特征(ROC)曲线下面积(AUC)为0.827,截断值为13.3%时,敏感度为71%,特异度为85.2%;PT的AUC为0.886,截断值为14.4 s时,敏感度为71%,特异度为88.9%。结论 ICG清除试验与Child-Pugh评分和肝脏生物化学指标存在相关性,ICG R15与PT联合应用可能可以更好地评估肝功能储备。
Objective This paper intends to compare and study the indocyanine green(ICG) clearance test and the Child-Pugh score, to evaluate the clinical application value, and to explore the correlation between the ICG clearance test and the Child-Pugh score. Methods From January 2016 to April 2017, 101 patients in the Department of Hepatology, the Fourth People′s Hospital of Qinghai Province were collected, including 41 cases of chronic hepatitis B(CHB) and 60 cases of hepatitis B cirrhosis(27 cases of Child-Pugh grade A and 33 cases of Child-Pugh grade B). ICG clearance test indicators(K value, estimated hepatic blood flow(EHBF), and ICG R15), Child-Pugh classification, and liver serum biochemical indicators(total bilirubin(TBil), albumin(Alb), and prothrombin time(PT)) of each group were compared, and the correlation between ICG clearance test and Child-Pugh classification was analyzed. Results The ICG R15, K value, PT, Alb in the CHB group were significantly different from those in the cirrhosis group(P<0.05). However, there was no significant difference in EHBF and TBil between the two groups. In the cirrhosis group, the Child-Pugh grade A group was compared with the Child-Pugh grade B group. With the increase of Child-Pugh classification, the levels of ICG R15, PT, and TBil increased, while the K value, EHBF, and Alb decreased, whose differences were statistically significant(P all<0.05). The area under the receiver operating characteristic(ROC) curve(AUC) of ICG R15 was 0.827, when the cutoff value was 13.3%, the sensitivity was 71%, and the specificity was 85.2%. The AUC of PT was 0.886, when the cutoff value was 14.4 s, the sensitivity was 71%, and the specificity was 88.9% respectively. Conclusions There is a correlation between the ICG clearance test and the Child-Pugh score and liver biochemical indicators. The combination of ICG R15 and PT may be a better assessment of liver function reserve.
Objective This paper intends to compare and study the indocyanine green(ICG) clearance test and the Child-Pugh score, to evaluate the clinical application value, and to explore the correlation between the ICG clearance test and the Child-Pugh score. Methods From January 2016 to April 2017, 101 patients in the Department of Hepatology, the Fourth People′s Hospital of Qinghai Province were collected, including 41 cases of chronic hepatitis B(CHB) and 60 cases of hepatitis B cirrhosis(27 cases of Child-Pugh grade A and 33 cases of Child-Pugh grade B). ICG clearance test indicators(K value, estimated hepatic blood flow(EHBF), and ICG R15), Child-Pugh classification, and liver serum biochemical indicators(total bilirubin(TBil), albumin(Alb), and prothrombin time(PT)) of each group were compared, and the correlation between ICG clearance test and Child-Pugh classification was analyzed. Results The ICG R15, K value, PT, Alb in the CHB group were significantly different from those in the cirrhosis group(P<0.05). However, there was no significant difference in EHBF and TBil between the two groups. In the cirrhosis group, the Child-Pugh grade A group was compared with the Child-Pugh grade B group. With the increase of Child-Pugh classification, the levels of ICG R15, PT, and TBil increased, while the K value, EHBF, and Alb decreased, whose differences were statistically significant(P all<0.05). The area under the receiver operating characteristic(ROC) curve(AUC) of ICG R15 was 0.827, when the cutoff value was 13.3%, the sensitivity was 71%, and the specificity was 85.2%. The AUC of PT was 0.886, when the cutoff value was 14.4 s, the sensitivity was 71%, and the specificity was 88.9% respectively. Conclusions There is a correlation between the ICG clearance test and the Child-Pugh score and liver biochemical indicators. The combination of ICG R15 and PT may be a better assessment of liver function reserve.
引文
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2 詹东昂,刘华.吲哚氰绿清除试验测定肝储备功能对肝癌治疗方案的指导价值[J].实用癌症杂志,2017,32(10):1663-1666.
3 唐哲,万仁瑞,胡红涛,等.吲哚箐绿实验对巴塞罗那B/C期肝癌患者行经导管动脉化疗栓塞术治疗的风险评估[J].中华实验外科杂志,2015,32(10):2365-2367.
4 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版).临床肝胆病杂志,2015,31(12):1941-1960.
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6 Scheingraber S,Richter S,Igna D,et al.Indocyanine green elimination but not bilirubin indicates improovement of graft function during MARS therapy[J].Clin Transplantat,2007,21(6):689-695.
7 黄丽雯,张灵.吲哚菁绿清除试验在肝功能储备功能评估及肝衰竭预后判断中的价值分析[J].西南军医,2016,18(3):254-256.
8 邱越,熊杰,彭英,等.吲哚氰绿清除试验对丙肝肝硬化脾切除术后门静脉血栓形成风险的预测价值[J].中国普通外科杂志,2014,23(1):87-90.
9 赖瑞敏,王明芳,朱月永.吲哚菁绿清除试验对乙型肝炎肝硬化患者肝功能储备功能的评估价值[J].临床肝胆病杂志,2016,32(9):1739-1742.
10 於展飞,熊明涛.半肝切除术中吲哚氰绿清除试验对残余肝功能储备功能的评估价值[J].中外医学研究,2015,13(17):147-148.
2 詹东昂,刘华.吲哚氰绿清除试验测定肝储备功能对肝癌治疗方案的指导价值[J].实用癌症杂志,2017,32(10):1663-1666.
3 唐哲,万仁瑞,胡红涛,等.吲哚箐绿实验对巴塞罗那B/C期肝癌患者行经导管动脉化疗栓塞术治疗的风险评估[J].中华实验外科杂志,2015,32(10):2365-2367.
4 中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年更新版).临床肝胆病杂志,2015,31(12):1941-1960.
5 Forman LM,Lucey MR.Predicting the prognosis of chronic live disease:An evolution from child to MELD[J].Hepatology,2001,33(2):473-475.
6 Scheingraber S,Richter S,Igna D,et al.Indocyanine green elimination but not bilirubin indicates improovement of graft function during MARS therapy[J].Clin Transplantat,2007,21(6):689-695.
7 黄丽雯,张灵.吲哚菁绿清除试验在肝功能储备功能评估及肝衰竭预后判断中的价值分析[J].西南军医,2016,18(3):254-256.
8 邱越,熊杰,彭英,等.吲哚氰绿清除试验对丙肝肝硬化脾切除术后门静脉血栓形成风险的预测价值[J].中国普通外科杂志,2014,23(1):87-90.
9 赖瑞敏,王明芳,朱月永.吲哚菁绿清除试验对乙型肝炎肝硬化患者肝功能储备功能的评估价值[J].临床肝胆病杂志,2016,32(9):1739-1742.
10 於展飞,熊明涛.半肝切除术中吲哚氰绿清除试验对残余肝功能储备功能的评估价值[J].中外医学研究,2015,13(17):147-148.