The Comparative Study Of Assessment For End-stage Liver Disease By Model For End-stage Liver Disease Combined With Indocyanine Green Clearance Test

Objective:Work out the effectiveness of indocyanine green clearance test on the evaluation of the liver’s storage function of hepatic cirrhosis and hepatic carcinoma victims.Here are subjects mainly explored:(1) Comparative analysis between indocyanine green clearance test,MELD,MELD-Na,MESO,iMELD,the four kinds of score and Child-Pugh classification of liver’s function. (2) Comparative analysis of interdependency between indocyanine green clearance test and MELD,MELD-Na,MESO,iMELD,the four kinds of score. (3) Comparative analysis of the rate of liver dysfunction after the hepatectomy for liver cancer in different levels of indocyanine green clearance. (4 Comparative analysis of interdependency between indocyanine green clearance test and MELD,MELD-Na,MESO,iMELD, the four kinds of score of hepatic cirrhosis brought about by different casuses.Method:Subjects of the project selected are end-stage liver disease victims who have received indocyanine green clearance test in the Department Two of general surgery of Lanzhou University First Attached Hospital from 2013.5 to 2014.6. The total number of them is 113,and 87 of it are male victims and 26 are female. Their age ranges from 18 to 72, and the average age is (50.52±11.05).33 of them are victims of hepatic cirrhosis, which are divided into hepatitis b hepatic cirrhosis and hepatitis c hepatic cirrhosis according to their different causes of disease. And 20 of them are victims of hepatitis b hepatic cirrhosis, while the other 13 are victims of hepatitis c hepatic cirrhosis.The number of Hepatocellular carcinoma victims who have both received operative therapy of hepatoccllular carcinoma and indocyanine green clearance test is 80.The functions of victims’ liver are all scored and classified accorading to the Child-Pugh scoring system,34 are accessed at A,55 are accessed at B and 24 are accessed at C. The indocyanine green clearance test detected constants value of K, value of R15 are detected by DDG-3300K analytic apparatus, and meanwhile work out MELD,MELD-Na,MESO,iMELD these four kinds of score of the victims with the help of model for end-stage liver disease and reformative model for end-stage liver disease scoring formula. And then make an interdependency analysis between indocyanine green (Value of K and R15) and the four kinds of score mentioned above. Make anthor interdependency analysis between indocyanine green (value of K and R15)and the four kinds of score according to the groups divided by different causes of diease. And also analyze the rate of liver dysfunction after hepatic operation in different levels of indocyanine green clearance.Results:Among the 113 victims of this project 34 are accessed at A in the Child-Pugh classification of liver’s function,55 are accessed at B and 24 are accessed at C. The values of K of A,B,C in the Child-Pugh classification of liver’s function are (0.179±0.053)/min, (0.164±0.067) /min, (0.089±0.042)/min. The values of R15 are (9.661±9.841)%, (13.732±14.601)%, (31.058±16.697)%. As the function of liver gradually decreases, the value of k tends to fall, while the value of R15 and MELD,MELD-Na,MESO,iMELD these four kinds of score tend to rise. And the comparison of there two groups are both of statistical significance (P<0.001). Value of K and R15 both have a good interdependency with MELD,MELD-Na,MESO,iMELD these four kinds of score, but the degrees of interdependency vary from each other, the correlation of R15 value is more obvious,compared with the K value and MELD,MELD-Na,MESO,iMELD score,of which the interdependency between value of R15 and iMELD score is most obvious.The interdependency of value of K and R15 in indocyanine green clearance test to victims of hepatic cirrhosis caused by different factors and MELD,MELD-Na,MESO,iMELD,the four kinds of score are different from each other, the correlation of R15 value is more obvious,compared with the K value and MELD,MELD-Na,MESO,iMELD score, and the interdependency value between R15 and iMELD score is most obvious.Paients were groups by liver function deteted before surgery.liver’s function and biochemical detection indes of victims in the relatively good group and the less serious group before operation are AST,ALT,TBIL,ALB,PT,INR,comparisons between these two groups are neither of statistical significance (P>0.05). However comparison of value of K and R15 in indocyanine green clearance test between the two groups is of statistical significance(P<0.001).Divide the victims into different groups according to value of R15 detected, and the rate of having liver dysfunction is 14% in group A,40% in group B,80% in group C after operation. And then make an comparative analysis in every two of these groups concluding that they are all of statistic significance(P<0.05). The three victims of serious liver dysfunction are all in group C,and the value of R15 detected are 39.3%,41.2%,45.7%, whose results are all beyond the normal range of value of R15.Conclusion:As the score and classification of Child-Pugh in liver’s function gradually decrease, the value of K falls, while the value of R15 rises, and scores of MELD,MELD-Na,MESO,iMELD gradually rise. The contants(value of K and R15)detected in indocyanine green clearance test are closely related to MELD,MELD-Na,MESO,iMELD these four kinds of score, of which the interdependency between R15 and the scores of four kinds of model for end-stage liver disease is more obvious than value of K with it,of which the interdependency between value of R15 and iMELD score is most obvious. In hepatitis b hepatic cirrhosis and hepatitis c hepatic cirrhosis the interdependency between R15 and MELD,MELD-Na,MESO,iMELD these four kinds of score is more obvious than value of K with it, of which the interdependency between value of R15 and iMELD score is most obvious. Indocyanine green clearance test and kind of scoring system of integrated MELD can effectively make a prognostic prediction of victims of hepatic cirrhosis. Not only can indocyanine green clearance test effectively and accurately evaluate liver’s storage function, it can also make a judgment and evaluation of having liver dysfunction after the hepatectomy for liver cancer.