CAJ | 학술논문

目的：探讨吲哚菁绿清除试验（ICG）联合AFP对 HBV相关性加急性肝衰竭（ACLF）短期预后的评估。方法回顾性分析55例 HBV 相关性 ACLF患者的临床资料，检测患者确诊为肝衰竭24 h内吲哚菁绿15分钟滞留率（ICGR15），同时记录24 h内各项检查指标，并计算MELD评分。采用Spearman等级相关分析ICGR15和AFP与血 TBil、INR、白蛋白、ALT、肌酐的相关性。对肝衰竭组患者进行3个月随访，确定存活及死亡情况，并对ICG R15、AFP进行分析。结果55例肝衰竭患者死亡25例。生存组与死亡组患者的年龄、TBil、AFP、ICGR15、肌酐、INR等比较差异有统计学意义（P＜0．05）。血清ICGR15与TBil和MELD评分呈正相关（r值分别为0．279、0．766，P均＜0．05），与血AFP呈负相关（r＝－0．311，P＜0．05）；血清AFP与TBil呈负相关（r＝－0．365，P＜0．05）。肝衰竭患者ICGR15≤50％组共17例，死亡3例；＞50％38例，死亡22例，2组比较，差异有统计学意义（χ2＝7．674，P＝0．006）。肝功能衰竭患者AFP≤10组共13例，死亡10例；AFP＞10组42例，死亡15例，2组比较，差异有统计学意义（χ2＝6．799，P＝0．009）。结论 ICGR15联合AFP能够较准确地预测HBV相关性ACLF的短期预后，肝衰竭患者 ICGR15＞50％、AFP＜10时预后较差。
목적：탐토신타정록청제시험（ICG）연합AFP대 HBV상관성가급성간쇠갈（ACLF）단기예후적평고。방법회고성분석55례 HBV 상관성 ACLF환자적림상자료，검측환자학진위간쇠갈24 h내신타정록15분종체류솔（ICGR15），동시기록24 h내각항검사지표，병계산MELD평분。채용Spearman등급상관분석ICGR15화AFP여혈 TBil、INR、백단백、ALT、기항적상관성。대간쇠갈조환자진행3개월수방，학정존활급사망정황，병대ICG R15、AFP진행분석。결과55례간쇠갈환자사망25례。생존조여사망조환자적년령、TBil、AFP、ICGR15、기항、INR등비교차이유통계학의의（P＜0．05）。혈청ICGR15여TBil화MELD평분정정상관（r치분별위0．279、0．766，P균＜0．05），여혈AFP정부상관（r＝－0．311，P＜0．05）；혈청AFP여TBil정부상관（r＝－0．365，P＜0．05）。간쇠갈환자ICGR15≤50％조공17례，사망3례；＞50％38례，사망22례，2조비교，차이유통계학의의（χ2＝7．674，P＝0．006）。간공능쇠갈환자AFP≤10조공13례，사망10례；AFP＞10조42례，사망15례，2조비교，차이유통계학의의（χ2＝6．799，P＝0．009）。결론 ICGR15연합AFP능구교준학지예측HBV상관성ACLF적단기예후，간쇠갈환자 ICGR15＞50％、AFP＜10시예후교차。
Objective To investigate the short‐term prognostic value of the indocyanine green clearance test (ICGR15 ) combined with serum alpha fetoprotein (AFP) for patients with hepatitis B virus associated acute‐on‐chronic liver failure (HBV‐ACLF) .Methods Clinical data of 55 patients diagnosed as HBV‐ACLF was retrospectively analyzed .ICGR15 and clinical data within 24h after diagnosis was collected for analysis and model for end stage liver disease(MELD) scores were calculated .The correlations between ICGR15 ,AFP and total bilirubin (TBil) ,international normalized ratio (INR) , albumin ,alanine aminotransferase (ALT ) and creatinine (Cr) were analyzed by Spearman rank correlation ,respectively . Those HBV‐ACLF patients for survival or death conditions were followed up for 3 months to evaluate the prognostic value of ICGR15 and AFP .Results The mortality rate of all HBV‐ACLF patients was 45 .45% .Comparison between the survival group versus the death group showed that age ,TBil ,AFP ,ICGR15 ,Cr and INR were significantly different (P<0 .05) .In addition ,ICGR15 level was positively correlated with TBil and MELD scores(r= 0 .279 , P<0 .05 ;r=0 .766 , P< 0 .05 , respectively) ,while negatively correlated with AFP level (r= -0 .311 , P< 0 .05) .The level of AFP in patients was negatively correlated with TBil level (r= -0 .365 ,P<0 .05) .ICGR15 were less than 50% in 17/55 HBV‐ACLF patients ,3 of which dead within 3 months with a mortality of 17 .65% .ICGR15 levels were more than 50% in 38/55 HBV‐ACLF patients ,22 of which dead within 3 months with a mortality of 57 .89% ,which revealed a statistically significant difference . Furthermore ,AFP levels were less than 10 in 13/55 patients ,10 of which dead within 3 months with a mortality of 79 . 62% .ICGR15 levels were more than 10 in 42/55 patients ,15 of which dead within 3 months with a mortality of 35 .71% , which revealed a statistically significant difference .Conclusion ICGR15 combined with AFP has a high value in predicting the short‐term prognosis for patients with HBV‐ACLF .HBV‐ACLF patients with ICGR15 level more than 50% or AFP level less than 10 might have a poor prognosis .