Yumoto Y, Umeda M, Ohshima K, Ogawa H, Kurokawa T, Kajitani M, Yumoto E, Hanafusa T, Tsuboi H, Higashi T
Radioisotope Center, Okayama University, Japan.
Cancer Chemother Pharmacol. 1994;33 Suppl:S1-6. doi: 10.1007/BF00686659.
To improve the results of hepatectomy in cirrhotic patients, the likely reserve function of the liver was evaluated before surgery. Asialoglycoprotein receptor (ASGP-R) is a hepatic cell surface receptor specific for galactose-terminated glycoproteins. Technetium-99m-diethylene triamine pentaacetic acid-galactosyl human serum albumin (99mTc-GSA) is a newly developed analog ligand to ASPG-R. The probable functional reserve of the remnant liver after hepatectomy was estimated preoperatively as the hepatic binding protein (HBP) concentration specific for ASGP-R on the hepatocellular membrane of the remnant liver. This estimate was based on the effective liver volume rate, obtained by the uptake of 99mTc-GSA. In all, 3 normal volunteers, 3 patients with chronic hepatitis (CH), 9 patients with liver cirrhosis (LC), 2 patients with hepatic cystadenoma, 3 patients with hepatocellular carcinoma (HCC) associated with CH, and 21 HCC patients with LC were studied. The mean value +/- SD obtained for HBP in normal volunteers (three cases) and in patients with mild (four cases), moderate (two cases), and severe liver damage (five cases) were 0.74 +/- 0.03 microM, 0.43 +/- 0.042 microM, 0.31 +/- 0.05 microM, and 0.20 +/- 0.05 microM, respectively. Most of the cases in which the preoperative HBP of the remnant liver was above 0.22 microM had a good postoperative course irrespective of the type of hepatectomy. On the other hand, in subjects with a remnant liver HBP of between 0.22 and 0.11 microM, postoperative severe liver dysfunction occurred in about 50% of cases. In all cases with a remnant liver HBP below 0.1 microM, the prognosis was very poor, indicating that hepatectomy should be avoided. The HBP concentration detected by the 99mTc-GSA study is a very sensitive indicator of changes in the hepatic functional reserve, and the HBP value for the functional reserve of the remnant liver is extremely useful for estimating the liver function before and after hepatectomy.
为提高肝硬化患者肝切除的效果，术前对肝脏可能的储备功能进行了评估。去唾液酸糖蛋白受体（ASGP-R）是一种对末端含半乳糖的糖蛋白具有特异性的肝细胞表面受体。锝-99m-二乙三胺五乙酸-半乳糖基人血清白蛋白（99mTc-GSA）是一种新开发的ASPG-R类似配体。肝切除术后残余肝脏的可能功能储备在术前通过残余肝脏肝细胞膜上ASGP-R特异性的肝结合蛋白（HBP）浓度来估计。该估计基于通过99mTc-GSA摄取获得的有效肝体积率。共研究了3名正常志愿者、3名慢性肝炎（CH）患者、9名肝硬化（LC）患者、2名肝囊腺瘤患者、3名合并CH的肝细胞癌（HCC）患者以及21名合并LC的HCC患者。正常志愿者（3例）以及轻度（4例）、中度（2例）和重度肝损伤患者（5例）的HBP平均值±标准差分别为0.74±0.03微摩尔/升、0.43±0.042微摩尔/升、0.31±0.05微摩尔/升和0.20±0.05微摩尔/升。无论肝切除类型如何，大多数残余肝脏术前HBP高于0.22微摩尔/升的病例术后病程良好。另一方面，在残余肝脏HBP为0.22至0.11微摩尔/升的受试者中，约50%的病例术后发生严重肝功能障碍。在所有残余肝脏HBP低于0.1微摩尔/升的病例中，预后非常差，表明应避免肝切除。99mTc-GSA研究检测到的HBP浓度是肝功能储备变化的非常敏感的指标，残余肝脏功能储备的HBP值对于评估肝切除前后的肝功能极为有用。
