慢性肝病患者肝功能储备与门静脉循环的（99m）Tc-GSA闪烁显像指标之间的关系

Relationship between (99m)Tc-GSA scintigraphic indices of liver function reserve and portal circulation in patients with chronic liver disease.

作者信息

Osada Hisato, Honda Norinari, Takahashi Takeo, Oku Shinya, Abe Atsushi, Watanabe Wataru, Okada Takemichi, Ohno Hitoshi, Hondo Mikito, Nishimura Keiichiro

机构信息

Department of Radiology, Saitama Medical Center, Saitama Medical School, 1981 Kamoda, Kawagoe, Japan.

出版信息

Ann Nucl Med. 2007 Jul;21(5):245-9. doi: 10.1007/s12149-007-0016-0. Epub 2007 Jul 25.

DOI:10.1007/s12149-007-0016-0

PMID:17634841

Abstract

OBJECTIVES

In order to predict the prognosis or complications of portal hypertension in patients with chronic liver disease, it is important to evaluate both hepatic functional reserve and portal circulation. On (99m)Tc-galactosyl human serum albumin ((99m)Tc-GSA) scintigraphy, the index of blood clearance (HH15) and receptor index (LHL15) have been widely used to evaluate the hepatic functional reserve. However, the relationship between these indices and portal circulation is unknown. The purpose of this study was to examine the relationship between HH15 and LHL15 and portosystemic shunts evaluated with arteriographic portography or esophagogastroduodenoscopy.

METHODS

A total of 82 patients with chronic liver disease (mean age, 66.7 years) who underwent (99m)Tc-GSA scintigraphy, arteriographic portography, and esophagogastroduodenoscopy were enrolled. HH15 and LHL15 were obtained from dynamic (99m)Tc-GSA scintigraphy. The patients were divided into three groups according to the arteriographic portography findings: group 1, no portal collateral circulation; group 2, mild collateral development; and group 3, moderate to severe collateral development. They were also divided into three groups based on the esophagogastroduodenoscopic findings: group A, no varices; group B, small-caliber varices; and group C, enlarged varices. The Kruskal-Wallis test was used to compare each index among these groups. Receiver operating characteristic (ROC) analysis was used to determine whether each index was an indicator for the presence of portosystemic shunts.

RESULTS

Both HH15 and LHL15 differed significantly between groups 1 and 2 and between groups 1 and 3. However, only HH15 differed significantly between groups A and B and between groups A and C. On the basis of the ROC analysis, the HH15 threshold value of 0.62 yielded both excellent sensitivity (83.9%) and specificity (84.6%) for the presence of portosystemic shunts, as evaluated with arteriographic portography. The HH15 threshold value of 0.64 yielded both good sensitivity (66.1%) and specificity (69.2%) for the presence of portosystemic shunts, as evaluated with esophagogastroduodenoscopy, whereas no adequate threshold value of LHL15 was found for the presence of portosystemic shunts.

CONCLUSIONS

HH15 is a potent indicator of the presence of portosystemic shunts in chronic liver disease.

摘要

目的

为预测慢性肝病患者门静脉高压的预后或并发症，评估肝功能储备和门静脉循环都很重要。在（99m）锝-半乳糖基人血清白蛋白（（99m）Tc-GSA）闪烁扫描中，血液清除指数（HH15）和受体指数（LHL15）已被广泛用于评估肝功能储备。然而，这些指数与门静脉循环之间的关系尚不清楚。本研究的目的是探讨HH15和LHL15与通过动脉造影门静脉造影或食管胃十二指肠镜检查评估的门体分流之间的关系。

方法

共纳入82例接受（99m）Tc-GSA闪烁扫描、动脉造影门静脉造影和食管胃十二指肠镜检查的慢性肝病患者（平均年龄66.7岁）。HH15和LHL15通过动态（99m）Tc-GSA闪烁扫描获得。根据动脉造影门静脉造影结果将患者分为三组：第1组，无门静脉侧支循环；第2组，轻度侧支形成；第3组，中度至重度侧支形成。根据食管胃十二指肠镜检查结果也将他们分为三组：A组，无静脉曲张；B组，小口径静脉曲张；C组，曲张静脉增大。采用Kruskal-Wallis检验比较这些组之间的各项指数。采用受试者工作特征（ROC）分析来确定每个指数是否为门体分流存在的指标。

结果

HH15和LHL15在第1组和第2组之间以及第1组和第3组之间均有显著差异。然而，只有HH15在A组和B组之间以及A组和C组之间有显著差异。根据ROC分析，对于通过动脉造影门静脉造影评估的门体分流的存在，HH15阈值为0.62时具有出色的敏感性（83.9%）和特异性（84.6%）。对于通过食管胃十二指肠镜检查评估的门体分流的存在，HH15阈值为0.64时具有良好的敏感性（66.1%）和特异性（69.2%），而未发现LHL15对于门体分流存在的合适阈值。