通讯作者: 伍玉南, wufly2000@163.com

DOI：10.12201/bmr.202507.00064

Prognostic predictive value of indocyanine green 15-minute retention rate combined with plasma ammonia and end-stage liver disease model score in patients with HBV-associated slow plus acute liver failure

• 摘要：摘要：目的：评估吲哚菁绿15分钟滞留率（indocyanine green retention rate at 15 minutes,ICG-R15）联合血浆氨、终末期肝病模型评分系统（MELD评分）对乙型肝炎病毒引起的慢加急性肝衰竭（HBV-ACLF）患者90天预后效果。方法：回顾性分析2021年7月至2024年11月湖南中医药大学第一附属医院肝病科收治的100例HBV-ACLF患者，按90天的生存结局分为生存组（n=70）和死亡组（n=30）。通过单因素及多因素回归分析筛选独立危险因素，采用Spearman分析指标间的相关性。绘制受试者工作特征曲线（ROC），评估单项指标及联合预测模型预测效能。结果：死亡组患者年龄、TBIL、PT、INR、ICG-R15、血氨浓度、MELD评分均显著高于生存组（P＜0.05）。多因素分析证实ICG-R15、血氨及MELD评分是HBV-ACLF患者90d死亡的独立危险因素（P＜0.05）。相关性研究表明MELD评分与ICG-R15（r=0.314, P<0.01）、血氨（r=0.237, P<0.05）呈正相关，血氨与ICG-R15间亦呈正相关（r=0.268, P<0.01）。ROC分析显示，ICG-R15、血氨及MELD评分预测90天预后的AUC分别为0.800、0.831、0.803。两两联合模型中，MELD+ICG-R15、MELD+血氨的AUC分别提升至0.881、0.864，三者联合的AUC最高（0.914），敏感度0.900，特异度0.857，约登指数0.757（95%CI：0.850~0.979）。结论：ICG-R15、血氨及MELD评分的升高与HBV-ACLF不良预后密切相关，三者联合检测模型在短期预后评估中展现出较高预测价值。

  关键词： 慢加急性肝衰竭; 吲哚菁绿15分钟滞留率; 终末期肝病模型评分; 预后预测; 联合检测

   

  Abstract: Abstract:Objective: To evaluate the 90-day prognostic effect of indocyanine green retention rate at 15 minutes (ICG-R15) in combination with plasma ammonia and Model for End-Stage Liver Disease score (MELD score) in patients with Hepatitis B Virus-induced Slow plus Acute Liver Failure (HBV-ACLF). Methods: One hundred patients with HBV-ACLF admitted to the Department of Hepatology of the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from July 2021 to November 2024 were retrospectively analyzed and divided into the survival group (n=70) and the death group (n=30) according to the 90-day survival outcome. Independent risk factors were screened by univariate and multivariate regression analyses, and the correlation between indicators was analyzed by Spearman analysis. Subjects work characteristic curves (ROC) were plotted to assess the predictive efficacy of single indicators and joint prediction models. Results: The age, TBIL, PT, INR, ICG-R15, blood ammonia concentration, and MELD score of patients in the death group were significantly higher than those in the survival group (P < 0.05). Multifactorial analysis confirmed that ICG-R15, blood ammonia, and MELD score were independent risk factors for 90-d death in HBV-ACLF patients (P < 0.05). Correlation studies showed that MELD score was positively correlated with ICG-R15 (r=0.314, P<0.01) and blood ammonia (r=0.237, P<0.05), as well as positively correlated between blood ammonia and ICG-R15 (r=0.268, P<0.01).ROC analysis showed that the AUCs for predicting 90-day prognosis for ICG-R15, blood ammonia and MELD score were 0.800, 0.831, and 0.803, respectively. In the two-by-two model, the AUCs of MELD+ICG-R15 and MELD+blood ammonia were elevated to 0.881 and 0.864, respectively, and the combination of the three had the highest AUC (0.914), with the sensitivity of 0.900, specificity of 0.857, and the Jordon index of 0.757 (95% CI: 0.850~0.979). 0.979). Conclusion: Elevated ICG-R15, blood ammonia and MELD score were closely associated with poor prognosis of HBV-ACLF, and the combined three-test model demonstrated high predictive value in short-term prognostic assessment.

  Key words: Acute-on-Chronic Liver Failure; Indocyanine Green 15-minute Retention Rate; Model for End-Stage Liver Disease Score; Prognostic Prediction; Combined Detection

  提交时间：2025-07-23

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• 序号	提交日期	编号	操作
  1	2025-05-22	10.12201/bmr.202507.00064V1	下载

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