吲哚菁绿排泄试验与肝癌患者肝动脉化疗栓塞术后肝衰竭的相关性分析

摘要

Objective To analyze the relevance of indocyanine green(ICG)excretion test, Child-Pugh classification and postoperative liver failure after transcatheter arterial chemoembolization(TACE)in liver cancer patients.Methods Retrospective analysis was made in the clinical data of 123 liver cancer patients who had received TACE,and the value of ICG clearance rate at 15 min(ICG-R15)and Child-Pugh classification after operation were assessed for liver function.Results Serum level of albumin was negatively correlated with ICG-R15 in 123 liver cancer patients(r = -0.643,P = 0.014),and prothrombin time and total bilirubin of 123 patients were positive correlated with ICG-R15(r =0.723,P =0.006,r =0.855,P =0.000),but alkaline phosphatase,aspartate aminotransferase and alanine aminotransferase were not correlated with ICG-R15.In 123 patients who received TACE treatment,22 cases presented liver failure, involving 12 cases in A grade and 10 cases in grade B.The level preoperative ICG-R15 and K value of patients in grade A were respectively (6.01± 3.11)% and (0.22±0.09)μg· kg-1 · min-1 , while those in grade B were (21.45±7.17)% and (0.09±0.06)μg·kg-1 ·min-1 ,the differences were statistically significant (P < 0.05 ).Conclusion ICG excretion test and Child-Pugh classification are sensitive indicators of postoperative liver function for TACE in liver cancer patients,and they have good correlation with liver failure,and provide guidance for reasonable treatment program and predicting treatment outcomes.%目的：分析吲哚菁绿（indocyanine green，ICG）排泄试验和 Child-Pugh 分级与肝癌患者肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）后肝衰竭的相关性。方法回顾性分析行 TACE 的123例肝癌患者的临床资料，探讨术前 ICG 排泄试验15 min 滞留率（ICG clearance rate at 15 min，ICG-R15）和 Child-Pugh分级对术后肝衰竭的评估价值。结果123例患者的血清白蛋白水平与 ICG-R15水平呈显著负相关（r ＝－0．643， P ＝0.014），凝血酶原时间和总胆红素水平与 ICG-R15水平呈显著正相关（r ＝0.723、P ＝0.006，r ＝0.855、P ＝0.000），血清碱性磷酸酶、天冬氨酸转氨酶和丙氨酸转氨酶水平与 ICG-R15水平无相关。患者在 TACE 后有22例出现肝衰竭，Child-Pugh 分级中 A 级有12例，B 级有10例；肝脏 Child-Pugh 不同分级中，A 级平均 ICG-R15水平和 K 值分别为（6．01±3.11）％和（0．22±0.09）μg·kg－1·min－1，B 级分别为（21．45±7.17）％和（0．09±0.06）μg· kg－1·min－1，差异均有统计学意义（P ＜0.05）。结论 ICG 排泄试验和 Child-Pugh 分级是评价肝癌患者 TACE 术后肝脏功能的灵敏指标，与肝衰竭具有良好的相关性，对于制定合理治疗方案、判断治疗预后有指导意义。