ICG R15对肝细胞癌患者接受立体定向放射治疗发生放射性肝损伤的预测价值  

ICG R15 in the Prediction of the radiation-induced liver damage of stereotactic body radiotherapy in patients with hepato cellular carcinoma

作　　者：孙静[1] 刘丽英[1] 杨晓 张爱民 张弢[1] 王佳 张丹 丁俊强 李文刚[1] 段学章[1] SUN Jing;LIU Li-ying;YANG Xiao;ZHANG Ai-min;ZHANG Tao;WANG Jia;ZHANG Dan;DING Jun-qiang;LI Wen-gang;DUAN Xue-zhang(Radiation Oncology Center,302 Military Hospital of China,Beijing 100039,China)

机构地区：[1]解放军第三0二医院肿瘤放射治疗中心,北京100039

出　　处：《肝脏》2018年第11期973-976,共4页Chinese Hepatology

基　　金：首都特色基金(Z171100001017181)

摘　　要：目的分析吲哚菁绿15分钟清除率(ICG R15)对原发性肝细胞癌(HCC)患者接受立体定向放射治疗(SBRT)发生放射性肝损伤(RILD)的预测价值。方法前瞻性分析2016年10月1日至2017年8月31日行SBRT的HCC患者150例,治疗前1周内测量ICG R15值,SBRT治疗后随访至少1年。根据实验室检查结果判定是否发生RILD,分析放疗前ICG R15与RILD发生的相关性。结果14例患者发生典型RILD,1例患者发生了不典型RILD。ChildPugh B级患者的ICG R15值为(34.275±16.544)%,明显高于Child-Pugh A级患者值(8.936±11.134)%。通过ROC曲线确定ICG R15截断值(对应敏感度和特异度分别为0.667和0.778)为11.3%。ICG R15<11.3%发生RILD的患者5例,ICG R15≥11.3%发生RILD患者10例(P=0.001)。多因素分析表明,放疗前ICG R15对预测RILD有意义,ICG R15≥11.3%组的相对危险度(RR)9.578,95%可信区间2.278～40.264(P=0.002)。结论放疗前ICG R15是SBRT治疗HCC患者发生RILD的有效预测因素。Objective To analyze the prediction value of indocyanine green 15-minute clearance rate （ICG R15） for radiation-induced liver damage （RILD） in patients with primary hepatocellular carcinoma （HCC） undergoing stereotactic body radiotherapy （SBRT）.Methods From October 1st, 2016 to August 31st, 2017, 150 patients with HCC employing SBRT were enrolled in this prospective study. The ICG R15 values were measured 1 week before treatment, and biochemical parameters were measured at least 1 year after SBRT. RILD was diagnosed according to the published criteria. The relationship between the ICG R15 and RILD were analyzed in these 150 patients. Results Typical RILD occurred in 14 patients （93.3%）, and atypical RILD occurred in 1 patient （6.7%）. ICG R15 in Child-Pugh B patients （34.275±16.544%） was significantly higher than that in Child-Pugh A patients （8.936±11.134 %）. ICG R15 cut-off value was defined as 11.3% by the receiver operating characteristic curve, whose corresponding sensitivity and specificity were 0.667 and 0.778, respectively. RILD occurred in 5 patients when ICG R15 was less than 11.3% and 10 patients when ICG R15 was more than 11.3% （ P =0.001）. Multivariate analysis showed that only ICG R15 before radiotherapy showed statistical significance in predicting RILD （RR 9.578, 95%CI： 2.278～40.264）.Conclusion ICG R15 value is an effective predictor of RILD in patients with HCC after SBRT.

关 键 词：原发性肝癌 吲哚菁绿15分钟清除率 放射性肝损伤 立体定向放射治疗 

分 类 号：R735.7[医药卫生—肿瘤] R730.55[医药卫生—临床医学]