原发性肝细胞癌患者术前染料排泄试验ICGR15检测与肝功能指标的比较研究  

A comparative study on preoperative ICGRls dye excretion detection and liver function indexes in patients with primary liver cancer

作　　者：徐玉兵[1] 房萌[1] 张洁[1] 沈佳斌[1] 饶春美 高春芳[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院实验诊断科,上海200438

出　　处：《中华检验医学杂志》2015年第11期733-736,共4页Chinese Journal of Laboratory Medicine

摘　　要：目的原发性肝细胞癌患者术前ICGR，，检测与肝功能指标相关性的研究。方法横断面调查。收集2014年5月至2015年3月在第二军医大学东方肝胆外科医院就诊的原发性肝癌患者192例，其中男160例，女32例，男女比例5：1，年龄26～72岁，平均50．5岁。对192例原发性肝癌患者采用脉搏光度法色素密度（PDD）法行吲哚菁绿（ICG）清除试验测定ICG15min滞留率（ICGR15），依据ICGR15检测值进行分段：ICGR15〈10％、ICGR1510％～20％、ICGR15〉20％，分析ICGR15；分段值在Child—Pugh分级中的比例；在检测ICGR15当日清晨空腹采集静脉血测定患者的肝功能指标：TBIL、TBA、TP、ALB、PA、ALT、AST、PT－INR、HA、LN、Ⅲ、Ⅳ、APRI、PLT等，采用Spearman非参数相关分析对ICGR，；与肝功能指标进行相关性分析。结果（1）192例患者ICGR15与Child—Pugh分级呈正相关（r=0．477，P〈0．01），分段值分层分析表明：不同ICGR15各分段值在Child—Pugh分级中所占比例有显著差异（P〈0．05）。（2）Child-Pugh分级与肝储备功能指标比较：随着Child—Pugh分级的递增，ICGR15值升高、ICG血浆清除率（ICGK值）和有效肝脏血流量（EHBF）降低，差异有统计学意义（P〈0．05）。（3）ICGR，；值与肝功能指标的相关性分析：ICGR15值与TBIL、TBA、ALT、AST、AFU、GGT、PT—INR、HA、LN、Ⅲ、Ⅳ、APRI指数：[（AST／ULN）×100／PLT（×10^9／L）]呈正相关性（r=0．422、0．389、0．219、0．301、0．219、0．244、0．325、0．652、0．403、0．523、0．519、0．434，P值均〈0．05）；与TP、AIJB、PA、SOD、WBC、PLT指标呈负相关（r=－0．290、－0．532、－0．546、－0．531、－0．256、－0．327，P值均〈0．05）。结论ICGR15作为肝脏储备功能动态定量指标能够比较全面地反映肝脏储备功能，与现有的临床肝功能Child—Pugh分级及肝功能生化指标相关，是反映术前肝脏�Objective To study the correlation between preoperative dye exclusion test and fiver function in patients with primary hepatic carcinoma. Methods This was a cross sectional survey. A total of 192 cases of primary liver cancer patients were recruited from May 2014 to March 2015 at the Second Military Medical University Affiliated Eastern Hepatobiliary Surgery Hospital. Hereinto, 160 cases were male and 32 females, the male to female ratio was 5： 1. The age of the patients ranged from 26 to 72 years old, and the average age was 50. 5 years old. ICG 15 minutes retention rate of ICG clearance test was determined by PDD method in 192 cases of primary liver cancer patients. ICGR15 value was stratified into three stages ： ICGR15 〈 10%, ICGRI510% -20% , and ICGR15 〉 20%. The ICGR15 stage of patients with different ChildPugh grades was analyzed. The biological liver function indexes of patients were simultaneous detected including TBIL, TBA, TP, ALB, PA, ALT, AST, PT-INR, HA, LN, Ⅲ, Ⅳ, APRI, PLT etc. The correlations of ICGR15 and biological indexes of liver function were analyzed using Spearman nonparametric correlation analysis. Results （ 1 ） ICGR15 was positively correlated with Child-Pugh grade （r = 0. 477, P 〈 0. 01 ） in the 192 cases of HCC. The hierarchical analysis showed that there were significant differences between ICGR15 and different Child-Pugh grades （ P 〈 0. 05 ）. （2） Child-Pugh classification and ICGR15 comparison further showed that, ICGR15 increased with Child-Pugh grade. While ICG plasma clearance rate （ICGK） and effective hepatic blood flow （ EHBF ） reduced （ P 〈 0. 05 ）. （ 3 ） The correlation analysis between ICGR15 and biological indexes of liver function showed that： ICGRls was positively correlated with TBIL,TBA, ALT, AST, AFU, GGT, PT-INR, HA, LN, III, IV and APRI index [ （AST/ULN） × 100] PLT （×10^9/L）] （r =0.422, 0.389, 0.219, 0.301, 0.219, 0.244, 0.325, 0.652,0.403, 0.523, 0. 519, 0. 434, P 〈 0. 05） ; and was negatively correla

关 键 词：癌 肝细胞 肝肿瘤 吲哚花菁绿 肝功能试验 

分 类 号：R735.7[医药卫生—肿瘤] R730.43[医药卫生—临床医学]