transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2010-0-1-30-36transplantologiya-266Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSКоличественная оценка функции печени методом клиренс-теста с индоцианином зеленымQuantitative assessment of hepatic function by indocyanine green clearance testДзидзаваИ. И.DzidzavaI. I.

Кафедра госпитальной хирургии 

Илья Игоревич Дзидзава 

Department of Hospital Surgery

dzidzava@mail.ruКотивБ. Н.KotivB. N.

Кафедра госпитальной хирургии

Department of Hospital Surgery

КашкинД. П.KashkinD. P.

Кафедра госпитальной хирургии

Department of Hospital Surgery

КочатковаА. А.KochatkovaA. A.

Кафедра госпитальной хирургии

Department of Hospital Surgery

БугаевС. А.BugayevS. A.

Кафедра госпитальной хирургии

Department of Hospital Surgery

СмородскийА. В.SmorodskyA. V.

Кафедра госпитальной хирургии

Department of Hospital Surgery

СлободяникА. В.SlobodyanikA. V.

Кафедра госпитальной хирургии

Department of Hospital Surgery

ФГУ ВПО МО РФ Военно-медицинской академии им. С.М. КироваРоссияS.M. Kirov Military Medical AcademyRussian Federation201017082018013036Copyright © Дзидзава И.И., Котив Б.Н., Кашкин Д.П., Кочаткова А.А., Бугаев С.А., Смородский А.В., Слободяник А.В., 20182018Дзидзава И.И., Котив Б.Н., Кашкин Д.П., Кочаткова А.А., Бугаев С.А., Смородский А.В., Слободяник А.В.Dzidzava I.I., Kotiv B.N., Kashkin D.P., Kochatkova A.A., Bugayev S.A., Smorodsky A.V., Slobodyanik A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/266

Целью исследования являлось изучение информативности и прогностической ценности динамической пробы функции печени с индоцианином зеленым (ИЦЗ) у больных циррозом. В исследование включены 149 больных циррозом печени и 20 пациентов без признаков заболевания печени – контрольная группа. Скорость плазменной элиминации ИЦЗ (СПЭИЦЗ) была достоверно ниже у пациентов основной группы (7,6±3,4% и 22,9±4,2% в 1 мин в основной и контрольной группах соответственно, р<0,001). C нарастанием тяжести гепатоцеллюлярной дисфункции, выявленным с помощью критериев Чайлда – Пью, показатели клиренса индоцианина прогрессивно ухудшались. СПЭИЦЗ у больных циррозом коррелировала с уровнями общего билирубина (r=-0,501, p<0,001), альбумина (r=0,494, p<0,001), международным нормализованным отношением (r=0,475, p<0,001) и индексом гистологической активности некровоспалительного процесса в печеночной паренхиме (r=-0,579, р<0,001). Медиана выживаемости больных циррозом была достоверно выше в случаях с более быстрой элиминацией ИЦЗ и составила при СПЭИЦЗ > 7% в 1 мин 20 мес, от 5 до 7% – 11,5 мес, а при СПЭИЦЗ < 5% – 6 мес (χ2 =51,9, p<0,001). Анализ ROC-кривых демонстрировал большую прогностическую ценность параметров клиренс-теста с ИЦЗ по сравнению с критериями Чайлда – Пью и MELD (c-statisticСПЭ 0,852±0,032; c-statisticCHILD 0,767±0,039, с-statisticMELD 0,758±0,041, р<0,001). Чувствительность и специфичность клиренс-теста в прогнозировании годичной выживаемости составили 86,5 и 76,8% соответственно. Таким образом, определение клиренса ИЦЗ является высокоинформативным и специфичным динамическим тестом, позволяющим оценить функциональные резервы печени. Включение данного критерия в существующие шкалы оценки тяжести гепатоцеллюлярной дисфункции позволит улучшить их диагностическую и прогностическую эффективность.

The purpose of the investigation was to study the informative and prognostic values of a dynamic hepatic function test using indocyanine green (ICG) in cirrhotic patients. The investigation covered 149 patients with hepatic cirrhosis (a study group) and 20 patients without signs of liver disease (a control group). The plasma ICG elimination rate (PICGER) was significantly lower in the study group (7.6±3.4 and 22.9±4.2% per min in the study and control groups, respectively; p < 0.001). With the progression of hepatocellular dysfunction revealed by the ChildPugh criteria, the indocyanine clearance values became progressively worse. In cirrhotic patients, PICGER correlated with the levels of total bilirubin (r = -0.501; p < 0.001), albumin (r = 0.494; p < 0.001), international normalized ratio (r = 0.475; p < 0.001), and the histological activity index of the necroinflammatory process in the hepatic parenchyma (r =-0.579; p < 0.001). In these patients, median survival was significantly higher in cases with prompter ICG elimination and, at a PICGER of > 7, 5 to 7, and <5% per min, it was 20, 11.5, and 6 months (χ2  = 51.9; p<0,001). Analysis of ROC curves demonstrated a greater prognostic value of the ICG clearance test than the Child-Pugh and MELD criteria (statisticPER, 0.852±0.032; c-statisticCHILD, 0.767±0.039, с-statisticMELD, 0.758±0.041; p < 0.001). The sensitivity and specificity of the clearance test in the prediction of annual survival were 86.5 and 76.8%, respectively. Thus, the determination of ICG clearance is a highly informative and specific dynamic test that estimates hepatic functional reserves. The inclusion of this criterion into the existing scales for rating the severity of hepatocellular dysfunction permits improvement of the diagnostic and prognostic efficiency of their use.

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The authors declare that there are no conflicts of interest present.