吲哚菁绿试验联合二维剪切波弹性成像技术评估供肝质量价值初探

目的探讨吲哚菁绿(ICG)试验联合二维剪切波弹性成像(2D SWE)技术评估供肝质量的临床价值。 方法回顾性分析2018年5月至2018年11月于青岛大学附属医院器官移植中心完成脑死亡器官捐献的21例供受者临床资料。供肝获取前均于本院ICU完成ICG试验和2D SWE检查。根据受者移植术后早期肝功能恢复情况,将6例发生早期移植物功能不全受者列为观察组,将15例早期肝功能正常受者列为对照组。采用两独立样本t检验比较观察组与对照组受者年龄和移植前末次终末期肝病模型评分以及供肝冷缺血时间、吲哚菁绿15 min滞留率(ICG-R15)、吲哚菁绿血浆清除率(ICG-PDR)和杨氏模量值。采用Wilcoxon符号秩和检验比较两组受者移植前末次Child-Pugh评分和无肝期时间。采用受试者工作特征(ROC)曲线评价ICG试验、2D SWE及2D SWE联合ICG试验对肝移植受者术后发生早期移植物功能不全的预测效果。P<0.05为差异有统计学意义。 结果观察组和对照组受者平均年龄分别为(38±13)岁和(54±6)岁,差异有统计学意义(t＝2.840,P<0.05)。观察组与对照组供者供肝ICG-R15分别为(5.5±3.0)%和(3.2±1.4)%,差异有统计学意义(t＝－2.386,P<0.05);ICG-PDR分别为(21±5)%/min和(24±4)%/min,杨氏模量值分别为(5.0±1.3)kPa和(3.9±2.6)kPa,差异均无统计学意义(t＝1.655和－0.930,P均>0.05)。ICG-R15预测肝移植术后发生早期移植物功能不全的ROC曲线下面积为0.767(95%CI：0.490～1.000,P>0.05),ICG-PDR为0.789(95%CI：0.513～1.000,P<0.05),2D SWE为0.756(95%CI：0.5392～0.9719,P>0.05),ICG-R15联合ICG-PDR为0.767(95%CI：0.490～1.000,P>0.05)。ICG-R15及ICG-PDR联合2D SWE预测肝移植术后发生早期移植物功能不全的ROC曲线下面积为0.822(95%CI：0.608～1.000,P<0.05),最佳阈值为ICG-R15＝4.15%,ICG-PDR＝21.7 %/min,杨氏模量值＝3.00 kPa,敏感度为83.3%,特异度为86.7%。 结论ICG试验联合2D SWE技术对肝移植术后早期移植物功能不全的预测优于2D SWE或ICG试验,且具有无创、简便和可定量评估等优势。

Preliminary study on the clinical value of the combined application of indocyanine green test and two-dimensional shear wave elastography in the assessment of donor liver quality

ObjectiveTo explore the clinical value of indocyanine green (ICG) test combined with two-dimensional shear wave elastography (2D SWE) in evaluating the quality of donor liver. MethodsA retrospective analysis of 21 brain-dead donors from the Organ Transplantation Center of the Affiliated Hospital of Qingdao University from May 2018 to November 2018 was conducted. All the donor livers were evaluated by ICG and 2D SWE test in ICU before donor liver acquisition. According to the early recovery of liver function, 21 recipients were divided into observation group (6 cases, recipients with early graft dysfunction after transplantation) and control group (15 cases). The age and modle for end-stage liver disease scores (last time before transplantation) of the recipients, and the cold ischemia time, ICG-R15, ICG-PDR and Young′s modulus of the donor liver between the 2 groups were compared by two independent samples t test. The Child-Pugh scores (last time before transplantation) and anhepatic stage between the 2 groups were compared by Wilcoxon signed-rank test. Receiver operator characteristic (ROC) was used to compare the predictive effect of different parameters on early allograft dysfunction after liver transplantation. P<0.05 was considered statistically significant. ResultsThe age of recipients of observation group and control group were (38±13) years and (54±6) years, respectively, the difference was statistically significant (t=2.840, P<0.05). The ICG-R15 of donor liver of observation group and control group were (5.5±3.0)% and (3.2±1.4)%, respectively, the difference was statistically significant (t=-2.386, P<0.05); the ICG-PDR of donor liver of observation group and control group were (21±5) %/min and (24±4) %/min, respectively, Young′s modulus of donor liver of observation group and control group were (5.0±1.3) kPa and (3.9±2.6) kPa, respectively, and there was no significant difference (t=1.655 and -0.930, P all>0.05). The area under ROC of ICG-R15 on predication of early graft dysfunction after liver transplantation was 0.767 (95%CI: 0.490-1.000, P>0.05), the area under ROC of ICG-PDR was 0.789 (95%CI: 0.513-1.000, P<0.05), the area under ROC of 2D SWE was 0.756 (95%CI: 0.5392-0.9719, P>0.05), the area under ROC of ICG-R15 and ICG-PDR was 0.767 (95%CI: 0.490-1.000, P>0.05). The area under ROC of ICG-R15, ICG-PDR and 2D SWE was 0.822 (95%CI: 0.608-1.000, P<0.05), the best cut-off for the prediction of early graft dysfunction were ICG-R15=4.15%, ICG-PDR=21.7 %/min, Young′s modulus=3.00 kPa, with a sensitivity of 83.3% and a specificity of 86.7%. ConclusionsThe prediction on early graft dysfunction after liver transplantation by ICG test combined with 2D SWE test was better than that by 2D SWE or ICG, with the advantage of non-invasive, simple and quantitative evaluation.