Value And Clinical Significance Of Effective Hepatic Blood Flow In The Assessment Of Liver Reserve Function

Objective:This study explored the value and clinical significance of EHBF by analyzing the relationship between effective hepatic blood flow(Effective hepatic blood flow,EHBF)and Child-Pugh classification in patients with cirrhosis.Method:In this study,we retrospectively analyzed 227 patients with cirrhosis who were hospitalized in the First Hospital of Jilin University from April 2011 to April 2018,including 46 patients with Child-Pugh grade A,115 patients with grade B,66 patients with grade C,and 56 patients with non-cirrhosis.Pulse Dye-Densitometry(Pulse Dye-Densitometry,PDD)was used to measure the effective hepatic blood flow,and serum albumin(albumin,ALB),prothrombin time(Prothrombin time,PT)and other biochemical indicators of liver function andthe indicators related to Indocyanine green(Indocyanine green,ICG)clearance test.The relationship among EHBF and Child-Pugh classification,serum albumin,prothrombin time and other indicators was analyzed.The measurement data obtained from the statistical analysis with SPSS 25.0software,and measurement data of normal distribution were expressed as mean+ standard deviation.t-test was used for comparison between two groups,and analysis of variance was used for comparison between multiple groups.Non-normally distributed measurement data were expressed as median(quartiles).Mann-Whitney U test was used for comparison between two groups,and Kruskal-Wallis H test was used for comparison between multiple groups.P<0.05 was statistically significant.The ROC curve was used to evaluate the sensitivity,specificity,positive predictive value,negative predictive value and the area under the ROC curve of EHBF,and to analyze the diagnostic efficacy of effective hepatic blood flow.The correlation between EHBF and serum albumin,prothrombin time and other indicators was analyzed by bilateral Spearman correlation analysis.To explore the value and clinical significance of EHBF.Result:(1)With the increase of Child-Pugh grading in patients with cirrhosis,the effective blood flow,serum albumin and prothrombin time of patients with cirrhosis were decreased and prolonged.There were significant differences in effective blood flow,serum albumin and prothrombin time among cirrhosis group and non-cirrhosis group,and between Child-Pugh A,B and C groups(P< 0.05).EHBF 0.839(0.580,1.235)L/min and ALB 36.65(34.33,41.03)g/L in the group non-cirrhosis were significantly higher than those in the group with cirrhosis(EHBF 0.387(0.255,0.571)L/min and ALB 29.25(26.10,34.10)g/L(P < 0.05).PT 12.10(11.10,12.85)s in the group without cirrhosis was significantly lower than PT 15.10(13.30,17.00)s in the group with cirrhosis(P< 0.05).EHBF 0.690(0.515,0.951)L/min,ALB 37.60(35.55,40.70)g/L in Child-Pugh A group were significantly higher than EHBF 0.397(0.265,0.536)L/min,ALB 29.60(27.20,33.50)g/L in Child-Pugh B group and EHBF 0.264(0.188,0.344)L/min,ALB 26.25(22.73,28.40)g/L in Child-Pugh C group(P< 0.05);PT 12.90(11.65,13.75)s in Child-Pugh A group was significantly lower than PT 14.70(13.50,15.90)s in Child-Pugh B group and PT 18.60(16.43,21.33)s in Child-Pugh C group(P < 0.05).PT 12.90(11.65,13.75)s in Child-Pugh A group was significantly lower than PT 14.70(13.50,15.90)s in Child-Pugh B group and PT 18.60(16.43,21.33)s in Child-Pugh C group(P <0.05).EHBF 0.397(0.265,0.536)L/min,ALB 29.60(27.20,33.50)g/L in Child-Pugh B group were significantly higher than EHBF 0.264(0.188,0.344)L/min,ALB 26.25(22.73,28.40)g/L in Child-Pugh C group(P < 0.05).PT14.70(13.50,15.90)s in Child-Pugh B group was lower than PT 18.60(16.43,21.33)s in Child-Pugh C group(P < 0.05),and the differences of the three observation indexes were statistically significant(P < 0.05).(2)The ROC curve was used to evaluate the diagnostic efficacy of EHBF.The ROC curve showed that when the AUC of the control group was 0.802(95% CI,0.728-0.876)and the diagnostic threshold was 0.647 L/min,the sensitivity was 82.40%,the specificity was 73.20%,the positive predictive value was 92.60%,and the negative predictive value was 50.60%;The AUC of Child-Pugh A for Child-Pugh B was 0.805(95% CI,0.731-0.880),the sensitivity was 73.00%,the specificity was 82.60%,the positive predictive value was 91.30%,and the negative predictive value was 55.10% when the diagnostic threshold was 0.504 L/min;The AUC of Child-Pugh B for Child-Pugh C was 0.727(95% CI,0.653-0.802),the sensitivity was 80.30%,the specificity was 57.40%,the positive predictive value was 51.50%,and the negative predictive value was 83.30% when the diagnostic threshold was 0.363L/min.(3)Spearman correlation analysis showed that the effective hepatic blood flow and indocyanine green 15 minute retention rate(Indocyanine green 15 minute retention rate,IGGR15),aspartate aminotransferase(Aspartate aminotransferase,AST),alkaline phosphatase(Alkaline phosphatase,ALP),total bilirubin(Total bilirubin,TBIL),prothrombin time(Prothrombin time,PT),international normalized ratio(International normalized ratio,INR),cholinesterase(Cholinesterase,CHE),serum albumin(Serum albumin,ALB),prothrombin activity(Prothrombin activity,PTA),platelets(Platelet,PLT)had a good correlation,and the correlation coefficients were-0.889,-0.298,-0.187,-0.578,-0.544,-0.487,0.432,0.528,0.518,and 0.137,respectively.Conclusion:The level of effective hepatic blood flow decreased with the progress of liver cirrhosis,which was helpful to judge the Child-Pugh grade of liver cirrhosis,and could reflect the reserve function of liver dynamically.The change of effective hepatic blood flow can be used as a reference index for the severity of cirrhosis.