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吲哚菁绿15分钟滞留率对HBV相关慢加急性肝衰竭患者病情及预后的评估价值
Clinical value of indocyanine green retention rate in condition analysis and prognostic evaluation of patients with HBV-related acute-on-chronic liver failure
文章发布日期:2016年09月28日  来源:  作者:刘精华,刘娜,刘晨希  点击次数:1215次  下载次数:280次

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【摘要】:目的分析吲哚菁绿15 min滞留率(ICG R15)对慢加急性肝衰竭(ACLF)病情及临床预后的评估价值,为ACLF患者的病情评估及预后评价提供参考指标。 方法以中国医科大学附属盛京医院2013年8月-2016年1月收治的127例ACLF患者为研究对象,按照临床分期分为早期组、中期组、晚期组,比较不同临床分期患者ICG R15、MELD评分及PT的差异,并按照患者90 d预后分为存活组、死亡组,比较两组患者上述指标间差异,总结ICG R15评价患者病情及预后的临床价值。 计量资料组间比较采用独立样本t检验或单因素方差分析,采用LSD-t检验进行两两比较;计数资料组间比较采用χ2检验。结果不同临床分期组间ICG R15、PT、MELD评分差异均有统计学意义(F值分别为7036、3.217、5.883,P值均<005),其中中期组、晚期组ICG R15、PT、MELD评分[(53.96±1001)%、(26.87±6.84)s、(31.56±4.17)分,(54.23±9.21)%、(28.43±3.61)s、(32.87±3.28)分]均高于早期组[(44.00±921)%、(19.79±2.82)s、(24.00±3.85)分],差异均有统计学意义(P值均<0.05)。死亡组ICG R15、PT、MELD评分[(53.91±5.83)%、(29.85±3.52)s、(33.81±4.67)分]均高于存活组[(45.03±4.33)%、(21.35±3.18)s、(25.30±4.02)分],差异均有统计学意义(t值分别为985、1420、1099,P值均<0.05)。以ICG R15=52%、PT=29 s、MELD评分=32分为截断值,不同指标水平患者病死率比较(22.39% vs 63.33%,25.71% vs 61.40%,21.54% vs 62.90%),差异均有统计学意义(χ2值分别为8831、6.263、7.583,P值均<0.05)。 结论随着ACLF患者病情的加重与预后质量的下降,其PT、MELD评分逐渐升高,且ICG R15亦有所上升,根据上述指标变化能够早期全面评估患者病情及临床预后。
【Abstract】:ObjectiveTo investigate the clinical value of indocyanine green retention rate at 15 min (ICG R15) in the condition analysis and prognostic evaluation of patients with acute-on-chronic liver failure (ACLF), and to provide a reference index for condition analysis and prognostic evaluation of patients with ACLF. MethodsA total of 127 ACLF patients who were admitted to our hospital from August 2013 to January 2016 were enrolled, and according to the clinical stage, they were divided into early-stage group, medium-stage group, and late-stage group. The ICG R15, Model for End-Stage Liver Disease (MELD) score, and prothrombin time (PT) were compared between the patients with different clinical stages. According to the prognosis at 90 days, the patients were divided into survival group and death group, and the above indicators were compared between the two groups. The clinical value of ICG R15 in condition analysis and prognostic evaluation was summarized. The independent samples t-test or a one-way analysis of variance was used for continuous data, the least significant difference method was used for comparison between any two groups, and the chi-square test was used for categorical data. ResultsCompared with the early-stage group, the medium-stage group and late-stage group had significantly higher ICG R15 (5396%±10.01%/54.23%±9.21% vs 44.00%±9.21%, P<0.05), PT (26.87±6.84 s/28.43±3.61 s vs 19.79±2.82 s, P<0.05), and MELD score (31.56±4.17/32.87±3.28 vs 24.00±3.85, P<0.05). The death group had significantly higher ICG R15, PT, and MELD score than the survival group (ICG R15: 53.91%±5.83% vs 45.03%±4.33%, t=9.85, P<0.05; PT: 29.85±3.52 s vs 2135±3.18 s, t=14.20, P<0.05; MELD score: 33.81±4.67 vs 25.30±4.02, t=10.99, P<0.05). With an ICG R15 of 52%, a PT of 29 s, and a MELD score of 32 as cut-off values, there were significant differences in mortality rate between the patients with different levels of indicators (ICG R15: 22.39% vs 64.29%, χ2=8.831, P<0.05; PT: 25.71% vs 61.40%, χ2=6.263, P<005; MELD score: 21.54% vs 62.90%, χ2=7.583, P<0.05). ConclusionWith the aggravation of the condition of ACLF and the reduction in prognosis, PT and MELD score increase gradually, and ICG R15 also increases. We can comprehensively evaluate patients′ condition and clinical prognosis in an early stage based on the changes in the above indicators.
【关键字】:肝功能衰竭; 吲哚花青绿; 预后
【Key words】:liver failure; indocyanine green; prognosis
【引证本文】:刘精华, 刘娜, 刘晨希. 吲哚菁绿15分钟滞留率对HBV相关慢加急性肝衰竭患者病情及预后的评估价值[J]. 临床肝胆病杂志, 2016, 32(11): 2155-2158.

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