Sugahara K, Togashi H, Shinzawa H, Matsuo T, Takeda Y, Miyano S, Haga H, Saito K, Saito T, Onodera Y, Takahashi K, Sugai Y, Saito H, Takahashi T
The Second Department of Internal Medicine, Yamagata University School of Medicine, Japan.
Tohoku J Exp Med. 1999 Jul;188(3):257-63. doi: 10.1620/tjem.188.257.
Fulminant hepatic failure is associated with a high mortality rate. Thus, accurate assessment of hepatic functional reserve and hepatic regeneration is important. We describe a 67-year-old woman who survived subacute hepatic failure. We had an opportunity to monitor the clinical course of the patient using single photon emission computed tomography (SPECT) with 99mTc-galactosyl-human serum albumin (99mTc-GSA) and frequent hematological examinations. On admission, prothrombin time was remarkably prolonged (23.1% of control). The liver uptake of 99mTc-GSA was also considerably low. She responded well to treatment. Four weeks after admission, SPECT analysis showed a dramatic increase in liver uptake of 99mTc-GSA, suggesting promotion of hepatic regeneration. Moreover, functional liver volume calculated from the SPECT data showed a marked increase at 4 weeks after admission, whereas CT scan showed no change at that point. This indicated that SPECT with 99mTc-GSA reflected functional hepatocytes more accurately than liver volume determined by CT scan, which cannot exclude nonfunctional hepatocytes. The patient's condition improved in parallel with the improvements in the indices measured by SPECT and hematological examinations. SPECT analysis is practically useful for the prompt assessment of improvement in patients with fulminant hepatic failure.
暴发性肝衰竭的死亡率很高。因此，准确评估肝功能储备和肝再生很重要。我们描述了一名67岁的女性，她在亚急性肝衰竭中幸存下来。我们有机会通过使用99m锝-半乳糖基人血清白蛋白（99mTc-GSA）的单光子发射计算机断层扫描（SPECT）和频繁的血液学检查来监测该患者的临床病程。入院时，凝血酶原时间显著延长（为对照值的23.1%）。99mTc-GSA的肝脏摄取也相当低。她对治疗反应良好。入院四周后，SPECT分析显示99mTc-GSA的肝脏摄取显著增加，提示肝再生得到促进。此外，根据SPECT数据计算的功能性肝体积在入院后4周时显著增加，而此时CT扫描显示无变化。这表明，与CT扫描确定的肝体积相比，99mTc-GSA SPECT能更准确地反映功能性肝细胞，因为CT扫描无法排除无功能的肝细胞。患者的病情随着SPECT和血液学检查所测指标的改善而改善。SPECT分析对于快速评估暴发性肝衰竭患者的病情改善实际有用。
