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

目的通过观察肝衰竭患者吲哚菁绿清除试验15 min滞留率(ICG R15)与其他常用肝脏储备功能指标变化,评判ICGR15对预测肝衰竭患者预后的价值。方法对32例肝衰竭患者采用脉搏光度分析法(即PDD法),检测入院时ICG R15,同时检测常用肝功能指标,包括ALT、AST、TBil、Alb、GGT、胆碱酯酶(CHE)、凝血酶原活动度(PTA)和胆固醇(CHO)。计算MELD评分。同时选取15例慢性肝炎患者、94例肝硬化患者作为对照,检测ICG R15及同期Alb、CHE、PTA和CHO。对肝衰竭组患者进行了3个月随访,确定存活及死亡情况,并对ICG R15、MELD评分进行受试者工作特征曲线(ROC曲线)分析,探讨其对预后的判断意义。结果(1)在慢性肝炎、肝硬化和肝衰竭组ICG R15、Alb、PTA、CHE、CHO在3组间差异均有统计学意义(P<0.05),其中ICG R15,Alb,CHE,PTA在慢性肝炎和肝硬化组差异有统计学意义(P<0.05);ICG R15、PTA、CHO在肝硬化和肝衰竭组差异有统计学意义(P<0.05)。(2)3个月时肝衰竭存活组与死亡组ICG R15分别为(50.05±9.04)%、(56.27±5.65)%,差异有统计学意义(P<0.05)。(3)对肝衰竭组ICG R15和MELD评分进行ROC曲线分析,二者曲线下面积分别为75.9%和60.4%,ICG R15对预后的判断优于MELD评分;当ICG R15为52.5%时对预后判断的敏感性为80%,特异性为70.6%。(4)肝衰竭组入院时ICG R15≤50%10例,3个月时死亡2例,病死率20%;>50%22例,3个月时死亡14例,病死率63.6%。结论 (1)在慢性肝炎、肝硬化和肝衰竭组,随着病情加重PTA逐渐下降,ICG R15逐渐升高,两者反映病情的严重程度优于其他指标。(2)比较ICG R15和MELD评分对肝衰竭患者的预后判别作用,ICG R15对3个月预后的判断优于MELD评分。(3)肝衰竭患者ICG R15>50%时预后较差。

Prognostic value of indocyanine green and liver reserve function in acute and acute - on - chronic liver failure patients

Objective To study the prognostic value of indocyanine green(ICG) R15 and other index of liver function in liver failure patients.Methods 32 patients with liver failure were analyzed for the ICG levels 15 minutes after injection(ICG R15) using pulse dye densitometry(PDD) at the time of admission and measured the level of index of liver function,such as Alb,CHE,PTA and CHO.Meanwhile MELD score was calculated.We also selected 15 cases of patients with chronic hepatitis,94 cases of liver cirrhosis as control groups,and checked the ICG R15,Alb,CHE,PTA and CHO at the time of admission.We observed and followed up those patients with liver failure for 3 months.In the liver failure group we evaluated the prognostic value of ICG R15,MELD score by the receiver-operator-characteristic curve analysis(ROC curves analysis).Results(1)The level of ICG R15,Alb,PTA,CHE and CHO In the chronic hepatitis group,liver cirrhosis group and liver failure group showed significant differences among the three groups(P<0.05).Significant differences of ICG R15,Alb,CHE and PTA were observed between the chronic hepatitis group and liver cirrhosis group(P<0.05);and that of ICG R15,PTA,CHO were between the liver cirrhosis group and liver failure group(P<0.05).(2)In liver failure group,ICG R15 in live group and death group were(50.05±9.04) % and(56.27±5.65) % in three months.The differences were statistically significant.(3)Area under the curve of MELD score was 60.4%%,and that of ICG R15 was 75.9%,which was better than MELD score.When ICG R15 was 52.5%,the sensitivity to predict death was 80% and specificity was 70.6%.(4)In liver failure group,there were 10 patients whose ICG R15 were less than 50%.2 of those 10 patients were dead within 3 months,the mortality was 20%.22 patients′ ICG R15 were more than 50%.14 of those 22 patients were dead within 3 months,the mortality was 63.6%.Conclusion(1)In the liver failure patients ICG R15 was g radually increased,and PTA was decreased.They were reflex severity of the disease.(2)By ROC curves analysis we found both of ICG R15 and MELD can make a prognosis in liver failure patients.Moreover the prognostic value of ICG R15 was better than that of MELD score.(3)The liver failure patients had a poor prognosis when their,ICG R15 were more than 50%.