吲哚菁绿清除试验联合终末期肝病模型对肝功能衰竭患者短期预后的评价  

Assessment of indocyanine green clearance test combined with the model for end-stage liver disease in the prediction of short-term prognosis for liver failure

作　　者：冯洪玲[1] 李谦[1] 王麟[1] 于万有[1] 袁桂玉 曹武奎[1] 杨积明[1] 

机构地区：[1]天津市第二人民医院ICU,300192

出　　处：《中华传染病杂志》2013年第10期593-597,共5页Chinese Journal of Infectious Diseases

基　　金：国家级“十一五”中医药防治重大传染病项目（2008ZXl005）

摘　　要：目的探讨吲哚菁绿清除试验和终末期肝病模型对肝功能衰竭患者短期预后的判断价值。方法回顾性分析80例肝功能衰竭患者，统计患者确诊为肝功能衰竭24h内吲哚菁绿15min滞留率（ICGR15），临床和实验室检查结果，以及3个月时预后结果，并计算终末期肝病模型（MELD）评分和伦敦国王学院医院标准（KCH）值。计量资料采用方差分析和t检验，计数资料采用7。检验，相关性分析采用Person相关系数检验。结果本组患者39例生存，41例死亡，病死率为51．2％。生存组与死亡组患者TBil分别为（288．0±109．1）和（340．7±108．2）μmol／L（t=2．172，P=0．033），Cr分别为（63．3±24．4）和（98．8±59．1）μmol／L（t’=3．540，P=0．001），ICGRl5分别为（48．1±10．2）％和（60．2±10．6）％（t=5．197，P=0．000），MELD评分分别为（20．6±4．4）和（26．9±7．1）分（t’=4．749，P=0．000），满足KCH标准的例数分别有6例（15．4％）和19例（46．3％）（X^2=8．916，P=0．003）。ICGR15在不同类型肝功能衰竭患者中比较，差异无统计学意义（F=1．353，P=0．264）。ICGRl5与MELD评分呈正相关（r=0．289，P=0．009）。将ICGR15和MELD评分引入Logistic回归分析，建立ICGR15-MELD模型：Logit（P）=0．105×ICGR15＋0．178×MELD-9．734。该模型受试者工作特征（ROC）曲线下面积为0．860，其最佳临界值为-0．3，相应的敏感度为85．40％，特异度为74．40％。而ICGRl5、MELD评分和KCH标准的ROC曲线下面积分别为0．791、0．770和0．655。结论ICGR15和MELD评分均能较好地预测肝功能衰竭患者短期预后，其预测能力优于KCH标准；ICGR15-MELD模型用于评价肝功能衰竭患者短期预后具有重要意义。Objective To investigate the efficacy of the indocyanine green （ICG） clearance test （ICGR15） combined with the model for end-stage liver disease （MELD） for assessing the short-term prognosis of patients with liver failure. Methods Eighty patients with liver failure were analyzed retrospectively. ICGR15 and relevant clinical data within 24 hours of diagnosis were analyzed. Meanwhile, the MELD score and Kingrs College Hospital （KCH） were evaluated. All findings were tested for correlation with 3-month mortality. Quantitative data were analyzed with analysis of variance and Student＇ s t-test. Count data were analyzed with chi-square test. Correlation analysis was performed with Pearsonrs coefficient test. Results Among 80 patients With liver failure, 39 patients survived and 41 died. The mortality rate of all patients was 51.2%. The serum total bilirubin,creainine concentrations, ICGR15, MELD scores and patient number in accordance with KCH criteria of surviving patients were （288. 0± 109. 1）μmol/L, （63. 3±24. 4） μmol/L, （48. 1±10. 2）%, 20.6±4. 4, and 6 cases, respectively, which were lower than those in dead patients [（340. 7 ± 108.2）μmol/L, （98.8± 59. 1 ） μmol/L, （60. 2 ± 10. 6）%, 26. 9 ± 7. 1 and 19 cases, respectively] （P=0. 033, P=0. 001,P=0. 000,P=0. 000 and P=0. 003, respectively）. There was no significant difference of ICGRIs among four types of liver failure. A positive correlation was observed between ICGRls and MELD score （r=0. 289, P=0. 009）. The ICGR15-MELD model was created by subjecting ICGR15 and MELD scores to Logistic regression analysis. The following ICGR15-MELD model, Logit （P） = 0. 105×ICGR15 ＋ 0. 178×MELD score -9. 734, was constructed by Logistic regression analysis. The area under the receiver operating characteristic （ROC） curve was 0. 860 and the cut-off- point of --0.3 had sensitivity of 85.40% and specificity of 74.40%. The area under the curve of the ICGR15-MELD model was significantly higher than those of ICGR15

关 键 词：肝功能衰竭 吲哚菁绿 模型 理论 预后 

分 类 号：R575.3[医药卫生—消化系统]