吲哚菁绿排泄试验预测轻微型肝性脑病的探讨  

The study on indocyanine green excretion test to predict mild hepatic encephalopathy

作　　者：李康来[1] 欧阳姗 郑丽花[2] 陈苑莉[2] 尤黎明[3] 林晓岚[2] Li Kanglai;OuYang Shan;Zheng Lihua;Chen Yuanli;You Liming;Lin Xiaolan(Department of Very Importent Patient,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Infectious Diseases,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;School of Nursing,Sun Yat-sen University,Guangzhou 545001,China)

机构地区：[1]中山大学附属第三医院特诊病区,广州510630 [2]中山大学附属第三医院感染性疾病科,广州510630 [3]中山大学护理学院,广州545001

出　　处：《中国实用护理杂志》2021年第15期1134-1139,共6页Chinese Journal of Practical Nursing

基　　金：广东省医学科学技术研究基金(A2019088);广东省护理学会科研课题(gdhlxueh 2019zx 312)。

摘　　要：目的探讨吲哚菁绿排泄试验中的吲哚菁绿15 min滞留率(ICG R15)和肝脏有效血流量(EHBF)能否预测轻微型肝性脑病(MHE)的发生。方法采用便利抽样法,收集2019年6—12月于广州中山大学附属第三医院诊治的确诊为肝硬化或肝衰竭的患者资料153例。用数字连接试验A和数字符号试验筛查出MHE患者,并分析临床资料。通过对R15和EHBF取不同数值作为分界点,分别探究两个因素对预测MHE的意义。结果MHE发生率为38.56%(59/153)。由单因素分析,Child-Pugh分级在MHE组和非MHE组的差异有统计学意义(χ^(2)值7.606,P<0.05),而肝硬化和肝衰竭诊断、空腹血糖、血清肌酐等的组间差异无统计学意义(P>0.05)。当选取0.11~0.61绝大多数点作为R15正常异常分界点时,R15具有统计学意义(P<0.05),并当R15选取0.18时最为显著(Fisher精确检验P值=0.00024);选取0.08~0.76绝大多数点作为EHBF正常异常分界点时,EHBF都具有统计学意义(P<0.05),并当EHBF选取0.25时最为显著(Fisher精确检验P值=0.00022)。通过Logistic逐步回归分析,得到MHE发生的危险因素为R15和EHBF,并利用ROC曲线说明两个因素对MHE的预测作用。结论MHE在肝硬化和肝衰竭患者的发生率较高。当R15≥0.18或EHBF≤0.25 L/min时,吲哚菁绿排泄试验中的R15和EHBF相较Child-Pugh分级更能预测MHE的发生,有助于及时对患者进行评估与管理。Objective To explore whether the 15-minute retention rate(R15)of indocyanine green(ICG)in the indocyanine green excretion test and the effective hepatic blood flow(EHBF)can predict the occurrence of mild hepatic encephalopathy(MHE).Methods Using the convenience sampling method,we collected clinic data from 153 patients diagnosed with liver cirrhosis or liver failure from June 2019 to December 2019 in the Third Affiliated Hospital of Sun Yet-sen University in Guangzhou.We screened the MHE patients with the number connect test-A and the digital symbol test,and analyzed the clinical data.By taking different values for R15 and EHBF as cut-off points,the significance of the two factors in predicting MHE is explored respectively.Results The incidence of MHE was 38.56%(59/153).Single factor analysis showed that the difference of Child-Pugh grade between the MHE group and the non-MHE group was statistically significant(χ^(2)value was 7.606,P<0.05),while the differences between cirrhosis and liver failure diagnosis,fasting blood glucose,and serum creatinine were not statistically significant(P>0.05).When most points between 0.11 and 0.61 were selected as normal and abnormal cut-off points of R15,R15 had statistical significance(P<0.05)and when R15 selected 0.18,it was most significant(Fisher exact test P=0.00024).When most points between 0.08 and 0.76 were selected as normal abnormal cut-off points of EHBF,EHBF had statistical significance(P<0.05)and when EHBF selected 0.25,it was most significant(Fisher exact test P=0.00022).Through Logistic stepwise regression analysis,the risk factors for MHE were R15 and EHBF.The ROC curve was used to illustrate the predictive effects of two factors on MHE.Conclusions The incidence of MHE in patients with cirrhosis or liver failure is high.When R15≥0.18 or EHBF≤0.25 L/min,R15 and EHBF in indocyanine green excretion test can better predict the occurrence of MHE than Child-Pugh classification,and can be help to evaluate and manage patients in time.

关 键 词：肝硬化 肝衰竭 轻微型肝性脑病 危险因素 吲哚菁绿排泄试 

分 类 号：R473.5[医药卫生—护理学]