吲哚菁绿清除试验在慢性重度肝炎患者12周预后的评估价值研究  

Prognostic Value of Indocyanine Green Clearance Test in Patients with Chronic Severe Hepatitis at 12 Weeks

作　　者：蔡遐 谢竟全 祝达 陈丽文 Cai Xia(Department of Hepatology,Zhongshan Second People’s Hospital,Zhongshan Gaungdong 528400)

机构地区：[1]中山市第二人民医院肝病科,广东中山528400

出　　处：《黑龙江医药》2022年第6期1247-1251,共5页Heilongjiang Medicine journal

基　　金：中山市医学科研项目(项目编号:2019J199)。

摘　　要：目的:探讨吲哚菁绿(ICG)清除试验15min滞留率(ICG R_(15))对慢性重度肝炎患者12周预后评估的价值。方法:回顾性分析2019年3月至2022年4月中山市第二人民医院收治的94例慢性重度病毒性肝炎患者的临床资料,上述患者入院时均通过脉搏光度分析法(PDD法)检测ICG R_(15),并行肝功能指标相关检查,同时计算其肝功能(CTP)评分、终末期肝病模型(MELD)评分、血清白蛋白-胆红素评分(ALBI)评分、肝纤维化(FIB-4)评分。对上述患者进行12周随访,确定预后情况,并通过受试者工作特征曲线分析ICG R_(15)、CTP评分、MELD评分、ALBI评分、FIB-4评分对预后的评估价值。结果:随访12周后,79例(84.04%)患者病情好转,15例(15.96%)患者病情恶化。恶化组的年龄、合并肝硬化率、ICGR15、TBil、PT、INR高于好转组(P<0.05);EHBF、ALT、ALB、PTA、PLT低于好转组(P<0.05)。logistic回归分析结果显示:ICGR_(15)是影响慢性重度肝炎患者12周预后的独立危险因素(P=0.031)。恶化组的CTP、MELD、ALBI、FIB-4评分均高于好转组(P<0.05)。由ROC曲线可知:ICGR15值和CTP、MELD、ALBI、FIB-4评分的ROC曲线下面积均>0.8,ICGR15的曲线下面积、最佳横断值、敏感性、特异性分别为0.911、39.2、80.00%、89.90%,除敏感性低于ALBI、FIB-4评分外,其余均优于其他评分。结论:随着ICGR_(15)值的上升,慢性重度肝炎患者病情恶化的风险不断增加。ICGR_(15)值和CTP、MELD、ALBI、FIB-4评分均可评估慢性重度肝炎患者12周预后,且ICGR_(15)值评估性能较好。Objective:To investigate the value of indocyanine green(ICG)clearance test 15-minute retention rate(ICG R15)in evaluating the prognosis of patients with chronic severe hepatitis at 12 weeks.Methods:The clinical data of 94 patients with chronic severe viral hepatitis admitted to Zhongshan Second People’s Hospital from March 2019 to April 2022 were retrospectively analyzed.ICG R15 was detected by pulse photometry(PDD)method at admission,and liver function indexes were examined.The liver function(CTP)score,model of end-stage liver disease(MELD)score,serum albumin-bilirubin score(ALBI)score and liver fibrosis(FIB-4)score were also calculated.The patients were followed up for 12 weeks to determine the prognosis.Receiver operating characteristic curve was used to analyze the prognostic value of ICG R15,CTP score,MELD score,ALBI score and FIB-4 score.Results:After 12 weeks of follow-up,79 patients(84.04%)improved and 15 patients(15.96%)deteriorated.The age,combined cirrhosis rate,ICGR15,TBil,PT and INR in the worsening group were higher than those in the improvement group(P<0.05).The levels of EHBF,ALT,ALB,PTA and PLT in the improvement group were lower than those in the improvement group(P<0.05).Logistic regression analysis showed that ICGR15 was an independent risk factor affecting the prognosis of patients with chronic severe hepatitis at 12 weeks(P=0.031).The scores of CTP,MELD,ALBI and FIB-4 in the deteriorated group were higher than those in the improved group(P<0.05).The ROC curve shows that:The area under the ROC curve of ICGR15 and CTP,MELD,ALBI and FIB-4 scores were all more than 0.8.The area under the ROC curve,optimal cross-sectional value,sensitivity and specificity of ICGR15 were 0.911,39.2,80.00%and 89.90%,respectively.The sensitivity was lower than ALBI and FIB-4 scores,and the other scores were better than other scores.Conclusion:With the increase of ICGR15,the risk of disease deterioration in patients with chronic severe hepatitis is increasing.ICGR15 value,CTP,MELD,ALBI and FIB-4 score can evaluate

关 键 词：吲哚菁绿 脉搏光度分析法 慢性重度肝炎 评分模型 预后 

分 类 号：R575.1[医药卫生—消化系统]