慢性肝炎肝硬化和肝衰竭患者吲哚菁绿清除试验的变化及其临床意义

目的 探讨吲哚菁绿(ICG)清除试验对不同程度慢性肝病患者肝脏储备功能的评估价值。方法 2017年11月～2019年8月山西医科大学第一医院感染病科住院治疗的肝病患者87例,其中慢性病毒性肝炎9例,肝硬化69例,慢性肝衰竭9例,使用日本DDG-3300K分析仪及配套分析软件检测ICG15分钟滞留率(ICG-R15)、ICG血浆清除率(K值)和有效肝脏血流量(EHBF),同时检测肝功能、血常规、腹部彩超、腹部CT或MRI,计算肝功能Child-Turcotte-Pugh(CTP)评分并对肝硬化患者分级。结果 慢性肝衰竭组ICG-R15为(54.2±11.6)%,K值为(0.04±0.01)/min,EHBF为(0.2±0.1)L/min,与慢性肝炎组比,差异显著【分别为(7.4±1.7)%、(0.22±0.05)/min和(0.9±0.3)L/min,P<0.05】;11例CTP C级患者ICG-R15为(39.3±8.9)%,K值为(0.06±0.02)/min,EHBF为(0.3±0.1)L/min,与39例CTP B级【分别为(28.8±12.6)%、(0.10±0.03)/min和(0.4±0.2)L/min,P<0.05】或19例CTP A级【分别为(12.2±2.8)%、(0.16±0.05)/min和(0.7±0.2)L/min,P<0.05】比,差异显著。结论 ICG清除试验能动态反映肝脏储备功能,弥补CTP分级的不足,尝试作为早期诊断肝硬化的参考指标,值得进一步研究。

Changes and clinical significance of indocyanine green clearance test in patients with chronic viral hepatitis,liver cirrhosis and liver failure

Objective The aim of this study was to estimate the changes and clinical significance of indocyanine green(ICG)clearance test in patients with chronic viral hepatitis,liver cirrhosis and liver failure.Methods A total of 87 patients with chronic liver diseases including chronic viral hepatitis in 9,liver cirrhosis in 69 and chronic liver failure in 9 were hospitalized in the Department of Infectious Diseases,First Hospital affiliated to Shanxi Medical University between November 2017 and August 2019.The ICG retention rate at 15 min(ICG-R15),ICG plasma clearance rate(K value)and effective hepatic blood flow(EHBF)were measured by DDG-3300K analyzer.Meanwhile,all the patients received blood hepatic functions,routine blood tests,abdominal color Doppler ultrasound,abdominal CT scan or MRI scan.The Child-Turcotte-Pugh(CTP)scores were calculated for classification.Results In patients with chronic liver failure,the ICG-R15 was(54.2±11.6)%,the K value was(0.04±0.01)/min,and the EHBF was(0.2±0.1)L/min,significantly different compared to【(7.4±1.7)%,(0.22±0.05)/min and(0.9±0.3)L/min,respectivel,P<0.05】in patients with chronic hepatitis;in 11 patients with liver cirrhosis CTP class C,the ICG-R15 was(39.3±8.9)%,the K was(0.06±0.02)/min,and the EHBF was(0.3±0.1)L/min,significantly different compared to【(28.8±12.6)%,(0.10±0.03)/min and(0.4±0.2)L/min,respectively,P<0.05】in 39 cirrhotic patients with CTP class B or【(12.2±2.8)%,(0.16±0.05)/min and(0.7±0.2)L/min,P<0.05】in 19 patients with CTP class A.Conclusion The ICG clearance test could reflect liver reserve functions,and it might be a dynamic parameter for liver function evaluation if we test it often.