Center of Functional and Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine 260, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Gastro Unit, Medical Division 360, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Hvidovre, Denmark.
J Gastroenterol Hepatol. 2019 Jun;34(6):1093-1099. doi: 10.1111/jgh.14470. Epub 2018 Oct 4.
Patients with cirrhosis and portal hypertension often develop complications relating to hepatic excretory dysfunction. The standard measurement of the hepatic excretion is the constant infusion indocyanine green clearance (ICG ) technique. The ICG 15-min retention test (ICG-r15) is faster, more patient friendly, and cheaper. The aims were to compare the ICG-r15 test with the standard method, to assess relations to patient characteristics and survival, and to assess the ICG-r15 level in healthy control subjects.
This study included 68 patients with cirrhosis and portal hypertension (Child class A/B/C:17/37/14). All patients underwent a full liver vein catheterization and hemodynamic evaluation with determination of ICG-r15 and ICG as the reference in a subset of 38 patients. Sixteen healthy control subjects were included for compiling a reference interval.
The ICG-r15 was increased in the cirrhotic patients with increasing values in parallel with liver dysfunction (15/41/58%) in Child class A/B/C compared with 7% in the controls (P < 0.001). ICG-r15 correlated highly significantly with the ICG (r = -0.96, P < 0.0001) and in a multivariate regression analysis with hepatic venous pressure gradient, markers of liver dysfunction and hyperdynamic circulation (P < 0.05-0.005). In the control group, normal reference values ranged from 0% to 13%. In addition, ICG-r15 was significantly related to mortality in the patient group (P = 0.02).
Indocyanine green-r15 reflects portal hypertension, the degree of hepatic failure, and survival and may replace the standard ICG . A more elaborated reference interval needs to be compiled, and the prognostic value of ICG-r15 should be validated.
肝硬化和门静脉高压患者常发生与肝排泄功能障碍相关的并发症。肝排泄的标准测量方法是恒速输注吲哚菁绿清除率（ICG）技术。ICG15 分钟保留试验（ICG-r15）更快、更适合患者且更便宜。本研究旨在比较 ICG-r15 试验与标准方法，评估其与患者特征和生存的关系，并评估健康对照组的 ICG-r15 水平。
本研究纳入了 68 例肝硬化和门静脉高压患者（Child 分级 A/B/C：17/37/14）。所有患者均接受了全面的肝静脉导管插入术和血流动力学评估，并在 38 例患者中测定了 ICG-r15 和 ICG。纳入 16 名健康对照者以制定参考区间。
肝硬化患者的 ICG-r15 升高，随着肝功能障碍的加重（Child 分级 A/B/C 分别为 15%/41%/58%），其值逐渐升高，而对照组为 7%（P<0.001）。ICG-r15 与 ICG 高度显著相关（r=-0.96，P<0.0001），并在多元回归分析中与肝静脉压力梯度、肝功能障碍和高动力循环标志物相关（P<0.05-0.005）。在对照组中，正常参考值范围为 0%至 13%。此外，ICG-r15 与患者组的死亡率显著相关（P=0.02）。
ICG-r15 反映门静脉高压、肝功能衰竭程度和生存情况，可能替代标准 ICG。需要制定更详细的参考区间，并验证 ICG-r15 的预后价值。
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