Chijiiwa K, Watanabe M, Nakano K, Noshiro H, Tanaka M
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Am J Surg. 2000 Feb;179(2):161-6. doi: 10.1016/s0002-9610(00)00274-9.
Correlation of the hepatic adenosine triphosphate (ATP) level with indocyanine green (ICG) excretion into bile was examined in patients with obstructive jaundice after the relief of hyperbilirubinemia by preoperative percutaneous transhepatic biliary drainage (PTBD).
Patients with complete bile duct obstruction, the mean serum total bilirubin concentration being 13.6 +/- 8.5 (SD) mg/dL, underwent PTBD prior to surgery. Within a few days before surgery when the mean serum total bilirubin level decreased to 1.2 mg/dL, ICG (0.5 mg/kg) was intravenously injected, and the whole bile was collected at 1-hour intervals for 5 hours. The ICG concentration in bile, bile flow rate, amount of ICG excreted in bile, and biliary ICG excretion rate as percentage of the injected dose were determined. At the time of surgery, a small liver tissue sample was obtained immediately after laparotomy without any ischemic procedures, and ATP concentrations were determined. Results of hepatic ATP levels were correlated with laboratory and clinical determinations.
The bile flow rate was essentially constant during the 5-hour period, the mean value being 21 mL/hour. The ICG concentrations in bile gradually increased, reached the maximal level in 3 hour, and declined thereafter. The biliary ICG excretion rate for 5 hours was 40% +/- 18% of its injected dose. The biliary ICG excretion rate and amount of ICG excreted in bile for 5 hours significantly (P <0.05) correlated with the hepatic ATP level. The decline index of serum bilirubin during PTBD was also correlated with the hepatic ATP level. The serum ICG retention rate, bile flow rate, maximal ICG concentration in bile, and other liver function tests including serum albumin and cholinesterase levels did not correlate with the hepatic ATP level.
Both the amount of and excretion rate of ICG in bile reflect the hepatic ATP level. Determination of biliary ICG excretion contributes to precise evaluation of hepatic energy status before surgery in patients with obstructive jaundice.
在术前经皮经肝胆道引流（PTBD）缓解高胆红素血症后，对梗阻性黄疸患者肝脏三磷酸腺苷（ATP）水平与吲哚菁绿（ICG）胆汁排泄之间的相关性进行了研究。
胆管完全梗阻患者，平均血清总胆红素浓度为13.6±8.5（标准差）mg/dL，术前接受PTBD。在手术前几天，当平均血清总胆红素水平降至1.2mg/dL时，静脉注射ICG（0.5mg/kg），并在5小时内每隔1小时收集全部胆汁。测定胆汁中ICG浓度、胆汁流速、胆汁中排泄的ICG量以及胆汁中ICG排泄率（以注射剂量的百分比表示）。手术时，在剖腹术后立即获取小块肝组织样本，不进行任何缺血处理，并测定ATP浓度。肝脏ATP水平的结果与实验室和临床测定结果相关。
在5小时期间胆汁流速基本恒定，平均值为21mL/小时。胆汁中ICG浓度逐渐升高，在3小时达到最高水平，此后下降。5小时的胆汁ICG排泄率为注射剂量的40%±l8%。5小时的胆汁ICG排泄率和胆汁中排泄的ICG量与肝脏ATP水平显著相关（P<0.05）。PTBD期间血清胆红素的下降指数也与肝脏ATP水平相关。血清ICG潴留率、胆汁流速、胆汁中ICG最高浓度以及包括血清白蛋白和胆碱酯酶水平在内的其他肝功能检查与肝脏ATP水平无关。
胆汁中ICG的量和排泄率均反映肝脏ATP水平。测定胆汁中ICG排泄有助于精确评估梗阻性黄疸患者术前的肝脏能量状态。
