应用去唾液酸糖蛋白受体及临床指标建立肝储备功能定量评估系统

摘要

目的：探讨应用肝细胞表面ASGPR流式细胞分析及临床指标建立肝储备功能定量评估系统，并与Child-Pugh评分进行比较，了解其在患者术前肝储备功能评估中的临床应用价值。方法选择32例肝占位病变行肝部分切除术患者，术前检测ICGR15与EHBF、R值与K值以及临床生化指标、Child-Pugh评分，以此作为自变量（Xn），以肝组织标本PHCASGPR+为因变量（Y），通过多元线性回归分析，建立肝储备功能定量评估系统，并与Child-Pugh评分进行比较，了解两种方法预测术后肝功能代偿情况的准确率。按照回归方程计算46例肝占位病变接受肝部分切除术及肝硬化并门脉高压症接受断流术患者肝储备功能定量值，评估肝储备功能情况，预测术后肝功能恢复情况，比较术前不同Child-Pugh分级与Y值患者术后肝功能恢复情况。结果在预测术后肝功能代偿良好准确率方面，Y值优于Child-Pugh分级（P =0.030）；而在预测术后肝功能代偿不良准确率方面，Y值与Child-Pugh分级无统计学差异（P =1.000）。结论新肝储备功能定量评估系统能一定程度提高肝切除或肝硬化患者术前肝储备功能评价准确度，具有临床应用价值。%Objective To investigate a quantitative assessment of hepatic functional reserve using flow cytometric analysis of asialoglycoprotein receptors (ASGPR) on the liver cell surface and regular clinical indexes. This assessment method was compared with the Child-Pugh score to evaluate its predictive value for hepatic functional reserve in patients undergoing liver resection or devascularization. Methods Total of 32 patients with liver tumors had partial hepatectomy. The percentage of the ASGPR+hepatocyte (PHCASGPR+), ICGR15, effective hepatic blood flow (EHBF), the R value, the K value and regular clinical parameters were examined to evaluate a quantitative assessment method for liver functional reserve. The PHCASGPR+was deifned as a dependent variable (Y) while the other indexs were deifned as independent variables (Xn). The accuracy of predicted postoperative liver compensation was obtained from follow-up information and was compared to that predicted by the Child-Pugh score. Total of 46 patients had partial hepatectomy or devascularization. The hepatic functional reserve was calculated with the new scoring system. The accuracy of predicted postoperative liver compensation was obtained from follow-up information and was compared to that predicted by the Child-Pugh score. Results The new scoring system (the Y value) had better accuracy in predicting postoperative hepatic functional reserve than Child-Pugh score (P = 0.030), but there were no statistical difference in predicting postoperative hepatic decompensation (P=1.000). Conclusions The quantitative assessment method for hepatic functional reserve, established in the current study, could provide a comprehensive evaluation of perioperative hepatic functional reserve in some degrees in patients undergoing hepatectomy or devascularization.