MELD-ICG对HBV/HCV肝硬化预后的评估价值  

Prognostic value of MELD-ICG in HBV/HCV cirrhosis: a prospective study

作　　者：江甫柱[1] 倪鎏达[2] 胡峰[3] 程明亮[1] 傅青春[2] 张懿[1] 金银鹏[1] 宾三勇 陈成伟[2] 

机构地区：[1]贵阳医学院,550001 [2]中国人民解放军第八五医院肝病中心 [3]吉林大学第一临床医院 [4]贵州六枝特区人民医院

出　　处：《肝脏》2013年第7期439-443,共5页Chinese Hepatology

基　　金：吴阶平医学基金会肝病医学部肝功能评估研究基金(LDWMF-PJ-2011D001);南京军区创新课题基金(10MB002)

摘　　要：目的探讨肝脏储备功能的动静态结合模型即终末期肝病模型联合吲哚菁绿清除试验(MELD-ICG)与常规肝脏功能评估指标的相关性及其对评估HBV/HCV肝硬化预后价值。方法收集乙型、丙型肝炎肝硬化患者88例,随访6个月,以死亡为终点目标。行常规肝脏生化检查及ICG清除试验,同时行CTP分级、MELD评分、MELD-Na评分及MELD-ICG评分(ICG参数用T1/2),并把MELD-ICG评分与上述指标进行相关性分析。结果在6个月随访期内88例患者中12例死亡。MELD-ICG评分与AST、TBil、DBil、PT、INR、ICGR15、ICGT1/2、CTP分级、MELD评分、MELD-Na评分、Alb、PA、Cr、Na、RBC、PTA、ICGK、ICGEHBF具有很好相关性(r=0.30、0.63、0.62、0.80、0.65、0.75、0.70、0.78、0.95、0.85、-0.49、-0.28、-0.39、-0.45、-0.30、-0.80、-0.42、-0.59),其中与MELD评分相关性最强(r=0.95)。与预后相关单因素为:ALT、AST、TBil、DBil、Alb、ALP、Na、WBC、PT、PTA、INR、ICGT1/2、ICGK、ICGR15、ICGREHBF、CTP分级、MELD评分、MELD-Na评分、MELD-ICG评分;多因素Cox回归分析获得与预后相关的独立危险因素为CTP分级、MELD-ICG评分;CTP分级的最佳临界值为C级时,敏感性和特异性分别为91.7%、76.3%,ROC曲线下面积为84.9%;MELD-ICG评分的最佳临界值为51时,敏感性和特异性分别为83.3%、88.2%,ROC曲线下面积为89.6%。结论 MELD-ICG能很好预测中晚期HBV/HCV肝硬化患者预后,尤其当MELD-ICG达到51时,对HBV/HCV肝硬化患者预后具有较高的敏感性和特异性。Objective To investigate the correlation between biological scores with incorporating indocyanin green clearance test and the Model for End Stage Liver Disease （MELIICG） diagnosis, and to evaluate the prognosis of liver cirrhosis caused by infection of chronic hepatitis t3 （HBV） or C （HCV）. Methods Eighty eight patients with cirrhosis caused by HBV / HCV were involved from the hospital. All patients were followed up for 6 months, and death was considered to be the end of the event; ICG clearance test （TI/2） and biological scores were performed , and Pugh score, MELD score, MELINa score, MELD-ICG score of patients with cirrhosis caused by HBV / HCV were calculated. Meanwhile we investigated the correlation between MELD-ICG score and all other scores. Results Twelve cases in 88 patients were confirmed dead in the 6 months＂ follow-up. MELD-ICG score was significant correlated with AST, TBil, DBil, PT, INR, ICG R15, ICG T1/2, CTP, MELD score, MELD-Na score, Alb, PA, Cr, Na, RBC, PTA, ICG K and ICG EHBF （r=0.30, 0.63, 0.62, 0.80, 0.65, 0.75, 0.70, 0.78, 0.95, 0.85, -0.49, 0.28, -0.39, -0.45, 0.30, -0.80, -I）. 42, -0. 59）. MELDqCG score had the most significant correlation with MELD score （r = 0. 95）. The variables, including AST, TBil, DBil, Alb, ALP, Na, WBC, PT, PTA, INR, ICG Tl/2, ICGK, ICGR15, ICGREHBF, CTP grade, MELD score, MELDNa score, MELD-ICG score, were related with prognosis of cirrhosis caused by HBV / HCV using univariate analysis. In all of these parameters, CTP grade and MELD-ICG score displayed to be related to prognosis of cirrhosis caused by HBV / HCV in multivariate Cox regression analysis. Area under the curve of CTP grade was 84.9% and that of MELDICG was 89.6%. When the grade of CTP was C, sensitivity to predict death was 91. 7% and specificity was 76.3%. When MELIICG score reached the value of 51, sensitivity to predict death was 83.3% and specificity was88.2 %. Conclusion Combination with incorporating indocyanin green clearance and MELD-ICG have significant correla

关 键 词：吲哚菁绿清除试验 CTP分级 MELD评分 HBV HCV肝硬化 预后 

分 类 号：R575.2[医药卫生—消化系统]