ICG荧光成像技术在移植肝灌注及功能评估中应用

doi:10.3877/cma.j.issn.2095-3232.2025.06.015

目的

探讨ICG荧光成像技术在移植肝灌注及功能评估中应用及其与移植术后移植物早期功能不全（EAD）的发生之间的关系。

方法

回顾性分析2021年1月至2022年2月在首都医科大学附属北京朝阳医院接受同种异体原位肝移植17例患者临床资料。患者和（或）家属均签署知情同意书，符合医学伦理学规定。其中男12例，女 5例；年龄 34~72岁，中位年龄51岁。在肝移植术中各管道吻合完成后静脉注射ICG，应用ICG荧光成像技术定量记录移植肝表面荧光强度变化，绘制荧光强度变化曲线，并评估其与移植肝灌注及EAD之间的关系。

结果

接受同种异体原位肝移植患者17例中4例发生EAD。术中及术后随访均未观察到ICG溶液注射相关的不良事件或不良反应，所有患者术后移植肝彩超检查均未见血栓，且肝脏血流通畅。手术前后乳酸变化（OR=1.420，95% CI：1.032~5.678，P=0.042）和荧光曲线参数a（OR=8.150，95% CI：1.022~16.498，P=0.028）是影响术后EAD发生的独立预测因素。参数a的最佳截断值为0.011，ROC曲线下面积为0.885（95%CI：0.723~1.000），预测肝移植术后7天EAD的发生敏感度为0.75，特异度为0.77。

结论

ICG荧光成像技术在移植肝灌注及功能评估中应用安全、可行，通过对荧光强度曲线进行多参数建模，计算荧光强度曲线参数a来分析荧光信号的时间变化，对于术后EAD的发生具有良好预测价值。

关键词: 吲哚菁绿, 荧光强度, 肝移植, 移植物功能, 移植物早期功能不全

Objective

To investigate the application of indocyanine green (ICG) fluorescence imaging in perfusion and functional evaluation of liver graft, and analyze its relationship with the incidence of early allograft dysfunction (EAD) after liver transplantation.

Methods

Clinical data of 17 patients undergoing orthotopic liver transplantation in Beijing Chaoyang Hospital, Capital Medical University from January 2021 to February 2022 were retrospectively analyzed. The informed consents of all patients and(or) their families were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 5 female, aged from 34 to 72 years, with a median age of 51 years. In liver transplantation, ICG was injected intravenously after vascular anastomosis. The changes of fluorescence intensity on the surface of liver graft were quantitatively recorded by ICG fluorescence imaging, and the curve of changes of fluorescence intensity was drawn. Its relationship with perfusion and EAD of liver graft was evaluated.

Results

EAD occurred in 4 of 17 patients undergoing orthotopic liver transplantation. No adverse events or adverse reactions related to ICG injection were observed intraoperatively and during postoperative follow-up. Postoperative color Doppler ultrasound detected no thrombosis and normal blood flow in the liver grafts of all patients. The changes of lactic acid level before and after surgery (OR=1.420, 95%CI: 0.956-5.678, P=0.045) and the parameters of fluorescence curve parameter a (OR=8.150, 95%CI:1.022-16.498, P=0.028) were the independent predictors for postoperative EAD. The optimal cut-off value of parameter a was 0.011, and the area under the ROC area under the curve was 0.885 (95%CI: 0.723-1.000). The sensitivity and specificity of predicting the incidence of EAD at 7 d after liver transplantation were 0.75 and 0.77, respectively.

Conclusions

ICG fluorescence imaging is safe and feasible for perfusion and functional evaluation in liver transplantation. The change of fluorescence signal time is analyzed by establishing the model of fluorescence intensity curve with multiple parameters and calculating fluorescence intensity curve parameter, which has high predictive value for the incidence of postoperative EAD.

Key words: Indocyanine green, Fluorescence intensity, Liver transplantation, Graft function, Early allograft dysfunction(EAD)

表1 肝移植术后EAD相关因素的单因素分析

因素	EAD(-)组	EAD(+)组	Z值	P值
男性受者(例)	9	3	-	0.824
受者年龄[岁, M(Min~Max)]	53(34~72)	48(34~67)	1.680	0.564
受者原发病(例)
肝细胞癌	3	0	-	0.290
酒精性肝硬化	3	0	-	0.290
乙肝肝硬化	3	2	-	0.301
丙肝肝硬化	1	0	-	0.568
自身免疫性肝硬化	1	0	-	0.568
胆汁性肝硬化	1	0	-	0.568
肝豆状核变性	0	1	-	0.063
药物性肝损害	0	1	-	0.063
硬化性胆管炎	1	0	-	0.568
受者BMI[kg/m², M(Min~Max)]	23.2(16.3~32.0)	21.8(18.8~25.1)	0.762	0.539
受者MELD评分[分, M(Min~Max)]	23(8~40)	31(25~35)	1.859	0.115
受者手术时间 [min, M(Min~Max)]	557(380~743)	646(425~830]	1.025	0.185
受者门静脉阻断时间[min, M(Min~Max)]	141(110~184)	178(152~196)	2.540	0.034
受者术中出血量[ml, M(Min~Max)]	750(400~1 800)	1 000(400~3 000)	1.985	0.078
受者入室乳酸[mmol/L, M(Min~Max)]	1.2(0.4~1.8)	1.4(1.1~1.7)	0.820	0.425
受者出室乳酸[mmol/L, M(Min~Max)]	1.3(0.5~3.0)	2.6(1.6~3.4)	1.250	0.390
受者手术前后乳酸变化[mmol/L, M(Min~Max)]	0.4(-0.9~1.2)	1.2(0.1~2.1)	2.645	0.016
男性供者(例)	11	3	-	0.659
供者年龄 [岁, M(Min~Max)]	51(23~68)	39(31~46)	1.894	0.077
供者BMI[kg/m², M(Min~Max)]	25.7(20.3~35.0)	25.8(22.2~29.4)	0.049	0.962
供肝CIT [min, M(Min~Max)]	397(180~480)	620(300~840)	2.192	0.078
荧光曲线参数B[M(Min~Max)]	74(71~76)	74(72~77)	0.606	0.553
荧光曲线参数a[M(Min~Max)]	0.012 4(0.010 6~0.014 1)	0.010 8(0.010 5~0.011 1)	2.809	0.013

表1 肝移植术后EAD相关因素的单因素分析

因素	EAD(-)组	EAD(+)组	Z值	P值
男性受者(例)	9	3	-	0.824
受者年龄[岁, M(Min~Max)]	53(34~72)	48(34~67)	1.680	0.564
受者原发病(例)
肝细胞癌	3	0	-	0.290
酒精性肝硬化	3	0	-	0.290
乙肝肝硬化	3	2	-	0.301
丙肝肝硬化	1	0	-	0.568
自身免疫性肝硬化	1	0	-	0.568
胆汁性肝硬化	1	0	-	0.568
肝豆状核变性	0	1	-	0.063
药物性肝损害	0	1	-	0.063
硬化性胆管炎	1	0	-	0.568
受者BMI[kg/m², M(Min~Max)]	23.2(16.3~32.0)	21.8(18.8~25.1)	0.762	0.539
受者MELD评分[分, M(Min~Max)]	23(8~40)	31(25~35)	1.859	0.115
受者手术时间 [min, M(Min~Max)]	557(380~743)	646(425~830]	1.025	0.185
受者门静脉阻断时间[min, M(Min~Max)]	141(110~184)	178(152~196)	2.540	0.034
受者术中出血量[ml, M(Min~Max)]	750(400~1 800)	1 000(400~3 000)	1.985	0.078
受者入室乳酸[mmol/L, M(Min~Max)]	1.2(0.4~1.8)	1.4(1.1~1.7)	0.820	0.425
受者出室乳酸[mmol/L, M(Min~Max)]	1.3(0.5~3.0)	2.6(1.6~3.4)	1.250	0.390
受者手术前后乳酸变化[mmol/L, M(Min~Max)]	0.4(-0.9~1.2)	1.2(0.1~2.1)	2.645	0.016
男性供者(例)	11	3	-	0.659
供者年龄 [岁, M(Min~Max)]	51(23~68)	39(31~46)	1.894	0.077
供者BMI[kg/m², M(Min~Max)]	25.7(20.3~35.0)	25.8(22.2~29.4)	0.049	0.962
供肝CIT [min, M(Min~Max)]	397(180~480)	620(300~840)	2.192	0.078
荧光曲线参数B[M(Min~Max)]	74(71~76)	74(72~77)	0.606	0.553
荧光曲线参数a[M(Min~Max)]	0.012 4(0.010 6~0.014 1)	0.010 8(0.010 5~0.011 1)	2.809	0.013

图1 移植肝行ICG荧光成像的荧光强度时间曲线

表2 肝移植术后EAD相关因素的Logistic多因素回归分析

因素	OR(95%CI)	P值
门静脉阻断时间(min)	0.890(0.793~1.002)	0.155
手术前后乳酸变化(mmol/L)	1.420(1.032~5.678)	0.042
荧光曲线参数a	8.150(1.022~16.498)	0.028

表2 肝移植术后EAD相关因素的Logistic多因素回归分析

因素	OR(95%CI)	P值
门静脉阻断时间(min)	0.890(0.793~1.002)	0.155
手术前后乳酸变化(mmol/L)	1.420(1.032~5.678)	0.042
荧光曲线参数a	8.150(1.022~16.498)	0.028

图2 荧光曲线参数a预测肝移植术后EAD的ROC曲线注：EAD为移植物早期功能不全

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Application of ICG fluorescence imaging in perfusion and functional evaluation of liver graft

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Application of ICG fluorescence imaging in perfusion and functional evaluation of liver graft