Preoperative assessment of congestive liver dysfunction using Technetium-99mm galactosyl human serum albumin liver scintigraphy in patients with severe valvular heart disease
Preoperative assessment of congestive liver dysfunction using Technetium-99mm galactosyl human serum albumin liver scintigraphy in patients with severe valvular heart disease
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DOI：
10.1007/s00595-006-3460-x
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发表时间：
2007-07-01
期刊：
影响因子：
2.5
通讯作者：
Sawa, Yoshiki
中科院分区：
文献类型：
--
作者：
Nishi, Hiroyuki;Takahashi, Toshiki;Sawa, Yoshiki
背景重症心脏瓣膜病常合并充血性肝功能障碍，严重影响手术效果。我们通过一种新的方法使用锝-99 m半乳糖基人血清白蛋白（Tc-99 m-GSA）和肝脏闪烁照相术来评估充血性肝功能障碍。方法。在1998年至2004年期间，我们对28例患有瓣膜性心脏病并伴有中度至重度三尖瓣返流且表现出右心衰竭症状的患者进行了Tc-99 m-GSA伴随的心血管造影。在此基础上，计算受体指数（LHL 15）和血液清除指数（HH 15），并评价这些因素与术后肝功能障碍（最大血清总胆红素水平（max T-bil）> 2.0mg/dl）的相关性。19名患者，包括4名在医院死亡的患者，术后肝功能障碍。肝功能异常组血清HH 15水平明显高于无肝功能异常组，胆碱酯酶水平明显低于无肝功能异常组（P < 0.05）。多因素Logistic回归分析显示HH 15是术后肝功能异常的最敏感指标。使用Tc-99 m-GSA的动脉造影计算的HH 15水平是严重瓣膜病患者术后肝功能障碍的临床有用预测因子。
Background. Severe valvular heart disease is often complicated by congestive liver dysfunction, which greatly compromises the operative results. We evaluated congestive liver dysfunction by a novel approach using technetium-99 m galactosyl human serum albumin (Tc-99m-GSA) with liver scintigraphy.Methods. Between 1998 and 2004, we performed scintigraphy accompanied by Tc-99m-GSA in 28 patients who had valvular heart disease with moderate-to-severe tricuspid regurgitation and who showed symptoms of right heart failure. Based on the results, we calculated a receptor index (LHL15) and an index of blood clearance (HH15) and assessed the correlation between these factors and postoperative liver dysfunction, defined as the maximum serum total bilirubin level (max T-bil) as > 2.0mg/dl.Results. Nineteen patients, including four who died in hospital, had postoperative liver dysfunction. The level of HH15 was significantly higher and the level of cholinesterase was significantly lower (P < 0.05) in patients with liver dysfunction than in those without liver dysfunction. Multivariate logistic regression analysis identified HH15 as the most sensitive indicator of postoperative hepatic dysfunction.Conclusion. The level of HH15 calculated using scintigraphy with Tc-99m-GSA is a clinically useful predictor of postoperative liver dysfunction in patients with severe valvular disease.