肝脏储备功能评估方法及临床意义
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摘要
肝脏是人体维持生命活动的重要器官之一,承担着代谢、合成、解毒、分泌、生物转化及免疫等多种生理功能。肝脏具有巨大的储备功能及再生能力,正常肝脏可耐受切除70%,而不出现明显的生理功能紊乱。若致肝损伤因素损害肝脏超过了肝脏的储备潜能,那么人体健康将受到严重威胁。因此,准确评估肝脏储备功能可为肝脏疾病进展、治疗效果以及预后的判断提供依据。目前,评估肝脏储备功能的方法繁多,各有其优缺点,至今没有哪一种可以单独全面评估肝脏储备功能,本文将针对介绍的各种评估方法的特点作一综述。
Liver is one of the important organs of the human body to maintain life activities, and bears many physiological functions such as metabolism, synthesis, detoxification, secretion, biotransformation and immunity. Liver has a huge reserve function and regenerative capacity, and the normal liver can tolerate 70% of resection without significant physiological dysfunction. If the liver damage factor damages liver beyond the reserve potential of the liver, then human health will be seriously threatened. Therefore, accurate assessment of liver reserve function can provide a basis for the judgment of liver disease progression, treatment outcome and prognosis. At present, there are many methods for assessing liver reserve function, each with its own advantages and disadvantages. So far, no one can comprehensively evaluate liver reserve function. This paper will review the characteristics of various evaluation methods introduced.
Liver is one of the important organs of the human body to maintain life activities, and bears many physiological functions such as metabolism, synthesis, detoxification, secretion, biotransformation and immunity. Liver has a huge reserve function and regenerative capacity, and the normal liver can tolerate 70% of resection without significant physiological dysfunction. If the liver damage factor damages liver beyond the reserve potential of the liver, then human health will be seriously threatened. Therefore, accurate assessment of liver reserve function can provide a basis for the judgment of liver disease progression, treatment outcome and prognosis. At present, there are many methods for assessing liver reserve function, each with its own advantages and disadvantages. So far, no one can comprehensively evaluate liver reserve function. This paper will review the characteristics of various evaluation methods introduced.
引文
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[2]李飞,陆伦根.肝功能异常的评估及临床意义[J].临床肝胆病杂志,2015,31(9):1543-1546.
[3]张东敬,周彬,侯金林.慢加急性肝衰竭预后模型的研究进展[J].临床肝胆病杂志,2018,34(6):1351-1356.
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[16]陆战,龚文锋,张志远,等.残肝体积/体重比率预测肝癌合并肝硬化患者术后肝功能衰竭的研究[J].肿瘤防治研究,2018,45(2):77-81.
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[22]SAITO K,LEDSAM J,SOURBRON S,et al.Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI:A preliminary study comparinggalactosyl human serum albu Mn scintigraphy with indocyaninegreen retention[J].Eur Radiol,2014,24(1):112-119.
[23]MORINE Y,ENKHBOLD C,IMURA S,et al.Accurate estimation of functional liver volume using Gd-EOB-DTPA MRI compared to MDCT/99mTc-SPECT fusion imaging[J].Anticancer Research2017,37(10):5693-5700.
[24]SATO T,ARITA J,INOUE Y,et al.Index of convexity:a novel method for assessing liver functional reserve using technetium-99m-galactosyl human serum albumin liver scintigraphy[J].BioScience Trends,2017,11(3):333-339.
[25]ZIPPRICH A,KUSS O,ROGOWSKI S,et al.Incorporating indocyanin green clearance into the model for end stage liver disease(MELD-ICG)improves prognostic accuracy in intermediate to advanced cirrhosis[J].Gut,2010,59(7):963-968.
[26]TANG YH,JU WQ,CHEN MG,et al.The combination of indocyanine green clearance test and model for end-stage liver disease score predicts early graft outcome after liver transplantation[J].Clin Monit Comput,2018,32(3):471-479.
[27]KOKUDO T,HASEGAWA K,AMIKURA K,et al.Assessment of preoperative liver function in patients with hepatocellular carcinoma the albumin-indocyanine green evaluation(ALICE)grade[J].PLoSOne,2016,11(7):e0159530.
[2]李飞,陆伦根.肝功能异常的评估及临床意义[J].临床肝胆病杂志,2015,31(9):1543-1546.
[3]张东敬,周彬,侯金林.慢加急性肝衰竭预后模型的研究进展[J].临床肝胆病杂志,2018,34(6):1351-1356.
[4]MALINCHOC M,KAMATH PS,GORDON FD,et al.A model to predict poorsurvival in patients undergoing transjugular intrahepatic portosystemicshunts[J].Hepatology,2000,31(4):864-871.
[5]PROHIC D,MESIHOVIC R,VANIS N,et al.Prognostic signifcance of ascites and serum sodium in patients with low meld scores[J].Medical Archives,2016,70(1):48-52.
[6]AGRAWAL S,DUSEJA A,GUPTA T,et al.Simple organ failure count versus CANONIC grading system for predicting mortality in acute-on-chronic liver failure[J].J Gastroenterol Hepatol,2015,30(3):575-581.
[7]LI N,HUANG CH,YU K,et al.Validation of prognostic scores to predict short-term mortality in patients with HBV-related acute-onchronic liver failure The CLIF-C OF is superior to MELD,CLIF SO-FA,and CLIF-C ACLF[J].Medicine,2017,96(17):e6802.
[8]RODRIGUES-FILHO EM,FERNANDES R,GARCEZ A.SOFA in the first 24 hours as an outcome predictor of acute liver failure[J].Rev Bras Ter Intensiva,2018,30(1):64-70.
[9]袁满,王丽春.吲哚氰绿清除试验在肝病中的应用进展[J].华西医学,2017,32(3):471-474.
[10]FAN ST.Liver functional reserve estimation:state of the art and relevancefor local treatments:the Eastern perspective[J].J HepatobiliaryPancreat Sci,2010,17(4):380-384.
[11]VOS J,WIETASCH JK,ABSALOM AR,et al.Green light for liver function monitoring using indocyanine green?An overview of current applications[J].Anaesthesia,2014,69(12):1364-1376.
[12]HAEGELE S,REITER S,WANEK D,et al.Perioperative non-invasive indocyanine green-clearance testing to predict postoperative outcome after liver resection[J].PLoS One,2016,11(11):e0165481.
[13]UCHIDA Y,FURUYAMA H,YASUKAWA D,et al.Hepatectomy based on future liver remnant plasma clearance rate of indocyanine green[J].HPB Surg,2016,2016:7637838.
[14]蔡伟,向飞,黄耀欢,等.三维可视化技术在巨块型肝癌可切除性评估及手术规划中的应用价值[J].中华消化外科杂志,2017,16(1):53-58.
[15]KISHI Y,ABDALLA EK,CHUN YS,et al.Three hundred and one consecutive extended right hepatectomies:evaluation of outcome based on systematic liver volumetry[J].Ann Surg,2009,250(4):540-548.
[16]陆战,龚文锋,张志远,等.残肝体积/体重比率预测肝癌合并肝硬化患者术后肝功能衰竭的研究[J].肿瘤防治研究,2018,45(2):77-81.
[17]YANG W,ZHANG X,LIU Y.Asialoglycoprotein receptor-targeted radio-pharmaceuticals for measurement of liver function[J].Curr Med Chem,2014,21(1):4-23.
[18]BEPPU T,HAYASHI H,OKABE H,et al.Liver functional volumetryfor portal vein embolization using a newly developed-galactosylhuman serum albumin scintigraphy SPECT-computed tomographyfusion system[J].J Gastroenterol,2011,46(7):938-943.
[19]DU S,MAO Y,TONG J,et al.A novel liver function evaluation system using radiopharmacokinetic modeling of technetium-99m-DT-PA-galactosyl human serum albumin[J].Nucl Med Commun,2013,34(9):893-899.
[20]MASAHIKO T,ATSUTAKA O,KENJI W,et al.Hepatic clearance measured with 99mTc-GSA single-photon emission computed tomography to estimate liver fibrosis[J].World J Gastroenterol,2014,20(44):16714-16720.
[21]IMURA S,SHIMADA M,UTSUNOMIYA T,et al.Recent advances in estimating hepatic functional reserve in patients with chronic liver damage[J].Hepatology Research,2015,45(1):10-19.
[22]SAITO K,LEDSAM J,SOURBRON S,et al.Measuring hepatic functional reserve using low temporal resolution Gd-EOB-DTPA dynamic contrast-enhanced MRI:A preliminary study comparinggalactosyl human serum albu Mn scintigraphy with indocyaninegreen retention[J].Eur Radiol,2014,24(1):112-119.
[23]MORINE Y,ENKHBOLD C,IMURA S,et al.Accurate estimation of functional liver volume using Gd-EOB-DTPA MRI compared to MDCT/99mTc-SPECT fusion imaging[J].Anticancer Research2017,37(10):5693-5700.
[24]SATO T,ARITA J,INOUE Y,et al.Index of convexity:a novel method for assessing liver functional reserve using technetium-99m-galactosyl human serum albumin liver scintigraphy[J].BioScience Trends,2017,11(3):333-339.
[25]ZIPPRICH A,KUSS O,ROGOWSKI S,et al.Incorporating indocyanin green clearance into the model for end stage liver disease(MELD-ICG)improves prognostic accuracy in intermediate to advanced cirrhosis[J].Gut,2010,59(7):963-968.
[26]TANG YH,JU WQ,CHEN MG,et al.The combination of indocyanine green clearance test and model for end-stage liver disease score predicts early graft outcome after liver transplantation[J].Clin Monit Comput,2018,32(3):471-479.
[27]KOKUDO T,HASEGAWA K,AMIKURA K,et al.Assessment of preoperative liver function in patients with hepatocellular carcinoma the albumin-indocyanine green evaluation(ALICE)grade[J].PLoSOne,2016,11(7):e0159530.