应用吲哚青绿试验与血栓弹力图替代去唾液酸糖蛋白受体分析定量评估肝储备功能  

Assessment of hepatic functional reserve by converted asialoglycoprotein receptor values calculated from parameters of indocyanine green test and thromboelastograph

作　　者：张珂[1] 蒋力[1] 贾哲[1] 李宝亮[1] 赫嵘[1] 黄容海[1] 鲁岩[1] 李勤涛[1] 丁振昊[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：《中华实验和临床感染病杂志（电子版）》2014年第3期39-42,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：首都临床特色应用研究项目(No.Z111107058811048)

摘　　要：目的应用吲哚青绿实验与血栓弹力图检测指标,替代肝细胞表面去唾液酸糖蛋白受体分析,建立肝储备功能定量评估系统,并与Child-Pugh评分进行比较,了解其在肝切除术患者肝储备功能评估中的临床应用价值。方法对2012年1月1日至12月31日于本科室行肝部分切除术肝占位病变的患者共55例,测量PHCASGPR+、ICGR15、EHBF、R值与K值,建立以PHCASGPR+为因变量(Y),ICGR15、EHBF、R值与K值为自变量(Xn)的肝储备功能定量评估系统,与Child-Pugh评分进行比较,了解两种方法预测术后肝功能代偿情况的准确率。结果 Child-Pugh预测术后肝功能代偿良好准确率为56.67%,Y值预测术后肝功能代偿良好准确率为84.62%(χ2=5.374,P=0.020);ChildPugh预测术后肝功能代偿不全准确率为76.00%,Y值预测术后肝功能代偿不全准确率为96.55%(χ2=5.400,P=0.020)。结论建立的肝储备功能定量评估系统能够更全面评价肝切除患者围手术期肝储备功能。Objective To verify the value of asialoglycoprotein receptors （ASGPR） analyzed by lfow cytometry （FCM） in assessing hepatic functional reserve, and establish a conversion formula for the ASGPR value with the parameters of indocyanine green （ICG） test and thromboelastography （TEG）. This assessment method was compared with the Child-Pugh score to evaluate its predictive value for hepatic functional reserve in patients undergoing liver resection.Methods Total of 55 patients with liver tumors had partial hepatectomy in our department from January 1st to December 31st, 2012. The percentages of ASGPR＋hepatocyte （PHCASGPR＋）, ICGR15, effective hepatic blood lfow （EHBF）, R value and K value were examined to establish the quantitative assessment method for liver functional reserve. The PHCASGPR＋ was defined as a dependent variable （Y） while the ICGR15, EHBF, R value and K value were defined as independent variables （Xn）. The accuracy of predicted postoperative liver compensation was obtained from the follow-up information and was compared with that predicted by Child-Pugh score.Results The accuracy of Child-Pugh score predicting postoperative hepatic functional reserve was 56.67%, while that of our method （the Y value） was 84.62% （χ2= 5.374,P = 0.020）. The accuracy of Child-Pugh score predicting postoperative hepatic decompensation was 76.00%, while that of the Y value was 96.55% （χ2= 5.400,P = 0.020）.Conclusions Our established quantitative assessment method for hepatic functional reserve could provide a comprehensive evaluation of perioperative liver reserve in patients undergoing hepatectomy.

关 键 词：肝切除 肝储备 去唾液酸糖蛋白受体 吲哚青绿试验 血栓弹力图 CHILD-PUGH评分 

分 类 号：R657.3[医药卫生—外科学]