Huang Yi-Shin, Chiang Jen-Huey, Wu Jaw-Ching, Chang Full-Young, Lee Shou-Dong
Department of Medicine, Taipei Veterans General Hospital, Taiwan.
Am J Gastroenterol. 2002 May;97(5):1223-7. doi: 10.1111/j.1572-0241.2002.05709.x.
Transcatheter arterial chemoembolization (TACE) is the major treatment modality for patients with unresectable hepatocellular carcinoma (HCC). Hepatic failure after TACE is relatively common in patients with preexisting liver dysfunction. The purpose of this study was to evaluate whether the monoethylglycinexylidide test and other parameters might predict hepatic failure after TACE in HCC patients.
One hundred forty-two HCC patients undergoing TACE were enrolled into this study. Before TACE, their venous blood was collected 15 min after a bolus injection of lidocaine (1 mg/kg body weight). A fluorescence polarization immunoassay was used to measure monoethylglycinexylidide oncentrations in their sera. Univariate and multivariate analyses were performed on the monoethylglycinexylidide test and other parameters between patients with and without hepatic failure after TACE.
Nineteen patients (13.4%) suffered hepatic failure after TACE. Univariate analysis revealed that the monoethylglycinexylidide concentration (17.7+/-5.8 vs 43.9+/-13.2 ng/ml), Child-Pugh score (6.9+/-0.6 vs 6.0+/-0.7), indocyanine green retention ratio at 15 min (32.4+/-6.5% vs 15.7+/-5.8%), prolonged PT, and serum total bilirubin and albumin showed significant differences between patients with and without hepatic failure after TACE. After a multiple logistic regression, only the monoethylglycinexylidide test was an independent predictor of hepatic failure (OR = 1.68, 95% CI = 1.07-2.65, p = 0.026). Among the 19 hepatic failure patients, three (15.8%) died of hepatic failure associated with TACE within 1 month after this procedure.
As a predictor of hepatic failure after TACE, the monoethylglycinexylidide test is better than conventional liver function tests and clinical parameters. The monoethylglycinexylidide test may be used to select patients with relatively good liver reserves for safe TACE treatment.
经动脉化疗栓塞术（TACE）是不可切除肝细胞癌（HCC）患者的主要治疗方式。TACE术后肝衰竭在已有肝功能不全的患者中相对常见。本研究的目的是评估单乙基甘氨酰二甲苯胺试验及其他参数是否可预测HCC患者TACE术后的肝衰竭。
142例行TACE的HCC患者纳入本研究。在TACE术前，静脉注射利多卡因（1mg/kg体重）15分钟后采集其静脉血。采用荧光偏振免疫分析法测定血清中单乙基甘氨酰二甲苯胺浓度。对TACE术后发生和未发生肝衰竭的患者的单乙基甘氨酰二甲苯胺试验及其他参数进行单因素和多因素分析。
19例患者（13.4%）TACE术后发生肝衰竭。单因素分析显示，单乙基甘氨酰二甲苯胺浓度（17.7±5.8 vs 43.9±13.2ng/ml）、Child-Pugh评分（6.9±0.6 vs 6.0±0.7）、15分钟时吲哚菁绿潴留率（32.4±6.5% vs 15.7±5.8%）、PT延长以及血清总胆红素和白蛋白在TACE术后发生和未发生肝衰竭的患者之间存在显著差异。多因素logistic回归分析后，只有单乙基甘氨酰二甲苯胺试验是肝衰竭的独立预测因素（OR = 1.68，95%CI = 1.07 - 2.65，p = 0.026）。在19例肝衰竭患者中，3例（15.8%）在该手术后1个月内死于与TACE相关的肝衰竭。
作为TACE术后肝衰竭的预测指标，单乙基甘氨酰二甲苯胺试验优于传统肝功能试验和临床参数。单乙基甘氨酰二甲苯胺试验可用于选择肝储备相对良好的患者进行安全的TACE治疗。
