应用Child-Pugh评分、吲哚青绿15min潴留率、去唾液酸糖蛋白受体与肝瞬时弹性值建立肝切除患者肝储备功能定量评估系统的初步研究  

Evaluation of hepatic functional reserve using Child-Pugh score,ICGR15,asialoglycoprotein receptor assay and transient elastography in partial hepatectomy patients

作　　者：贾哲[1] 张珂[1] 蒋力[1] 黄容海[1] 李宝亮[1] 鲁岩[1] 赫嵘[1] 丁振昊[1] 李勤涛[1] 郭立民[1] 穆毅[1] 

机构地区：[1]首都医科大学附属北京地坛医院肝胆外科,北京100015

出　　处：《中华临床医师杂志（电子版）》2013年第11期42-45,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：首都临床特色应用研究(Z111107058811048)

摘　　要：目的联合运用Child-Pugh评分、吲哚青绿(ICG)试验、去唾液酸糖蛋白受体(ASGPR)及肝瞬时弹性值(TE),建立肝切除患者肝储备功能定量评估系统。方法对2011年1月至2012年12月在我科行肝切除的104例患者,术前测定Child-Pugh评分、吲哚青绿15 min潴留率(ICGR15)、肝细胞ASGPR荧光强度及TE,并使用术后2周Child-Pugh评分评估肝功能恢复情况。利用多元线性逐步回归分析法筛选影响术后肝功能恢复的指标,以术后肝功能Child-Push评分为因变量(Y值),以筛选指标为自变量(Xn),建立肝储备功能评估方程。结果利用多元线性逐步回归分析法筛选得出ASGPR、Child-Pugh评分、ICGR15与TE是影响术后肝功能恢复的敏感指标,并可建立多元线性回归方程为Y=6.3050-0.0543X1+0.4980X2+0.1150X3-0.0637X4,该模型能够解释术后肝功能85.8%变差,而单独使用Child-Pugh评分仅能解释术后肝功能66.0%变差。结论术前联合应用Child-Pugh评分、ICGR15、ASGPR与TE能够提高Child-Pugh评分评估肝切除患者肝储备功能准确率,具有一定的临床应用价值。Objective To establish an innovative quantitative assessment of hepatic functional reserve using Child-Pugh score,ICGR15,ASGPR and transient elastography （TE）.Methods A total of 104 patients with partial hepatectomy in our department from January 2011 to December 2012 were involved in this study.The Child-Pugh score,ICGR15,ASGPR and TE were examined to establish the quantitative assessment method for liver functional reserve.Child-Pugh score was examined after two weeks of operation and defined as a dependent variable （Y） while the pre-operative Child-Pugh score,ICGR15,ASGPR and TE were defined as independent variables （Xn）.Results ASGPR,Child-Pugh score,ICGR15 and TE were sensitive values to predict hver function after surgery through stepwise multiple regression analysis,as well as the multiple regression equation was established with Y =6.3050-0.0543X1 ＋ 0.4980X2 ＋ 0.1150X3-0.0637X4.Compared with Child-Pugh score alone,the new method was more accurate to predict the variation of postoperative hepatic function.Conclusion The combined application of Child-Pugh score,ICGR15,ASGPR and TE could improve the accuracy of evaluating hepatic functional reserve in partial hepatectomy patients.

关 键 词：吲哚花青绿 去唾液酸糖蛋白受体 弹性成像技术 肝功能 CHILD-PUGH评分 

分 类 号：R657.3[医药卫生—外科学]