CN112107305A - Detection method and detection device for effective liver blood flow and storage medium - Google Patents
Detection method and detection device for effective liver blood flow and storage medium Download PDFInfo
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Abstract
A detection method, a detection device and a storage medium for effective liver blood flow, wherein the detection method comprises the following steps: acquiring spectroscopic detection data of the probe; calculating to obtain the ICG real-time concentration and the ICG clearing rate in the human blood according to the light splitting detection data; calculating the circulating blood volume of the human body according to the ICG dosage and the ICG real-time concentration in the ICG elimination test; the product of the circulating blood volume and the ICG clearance rate is used for analyzing to obtain the effective liver blood flow of the human body. The technical scheme simplifies the measurement formula of effective liver blood flow EHBF to a certain extent, avoids calculation errors possibly caused by some calculation parameters, and is beneficial to improving the accuracy of EHBF detection, thereby enhancing the reference value of the EHBF index in clinical application; in addition, the technical scheme firstly calculates the ICG clearance rate and the circulating blood volume, and then calculates the EHBF index, thereby providing a reliable solution for the monitoring of the EHBF index only by one-time measurement in clinic at present.
Description
Technical Field
The invention relates to the technical field of medical detection, in particular to a method and a device for detecting effective liver blood flow and a storage medium.
Background
The method for evaluating the effective liver function is mainly Indocyanine Green Clearance Test (ICG Test). The detection principle of the indocyanine green clearing test is based on the pharmacological property of indocyanine green, namely that the indocyanine green can be combined with plasma protein after being injected into a human body through a peripheral vein, is rapidly distributed to each circulation organ, and is discharged through the self-circulation of liver cells. Normal persons have only 3% of blood left after ICG injection and 20 minutes passed, and the clearance rate of ICG is closely related to the liver function status of the subject only, since ICG is cleared in vivo only by the liver. In addition, the non-toxic property of the ICG has no side effect on other visceral organs, so that the safety of indocyanine green clearing tests in clinical application is greatly improved.
Effective Hepatic Blood Flow (EHBF) is one of the indicators for evaluating Effective liver function. EHBF mainly refers to liver blood flow which is contacted with liver cells to play a metabolic function, reflects the change of liver blood flow perfusion and cell metabolism conditions, and is a sensitive index for evaluating whether liver region perfusion and metabolism are effective or not. EHBF has irreplaceable value in the aspects of evaluating microcirculation, inflammation activity degree and the like of chronic liver disease patients, but is limited by the performance of clinical equipment, and the detection and analysis cannot be fully carried out.
The measurement of effective hepatic blood flow is mainly divided into direct and indirect methods. The direct method is to directly measure the difference between the hepatic blood flow and the hepatic blood flow of the liver, and can only be carried out in the operation at present, the operation process is complex, and the obtained result is not accurate enough. Indirect methods refer to the assessment of effective hepatic blood flow in a patient by detection of metabolism of an indicator in the subject. At present, the main forms of indirect methods are metabolic clearance, hepatobiliary clearance and interstitial clearance. Indicators mainly used in the metabolic clearance method comprise galactose, lactose and the like, and the main principle is the formation of urea and the metabolism of galactose or lactic acid by liver cells; the interstitial clearance method is developed by mainly utilizing indicators such as chromium phosphate, colloidal gold, heat-denatured iodine and the like and utilizing the principle that macrophages in the liver can clear away colloids with certain sizes in blood. The hepatobiliary elimination method is mainly performed by using the principle that an indicator such as indocyanine green (ICG) is excreted from bile ducts after being metabolized by liver cells in the liver.
At present, a manual detection mode and an equipment detection mode are mainly adopted for carrying out an indocyanine green clearing test. In the manual detection mode, the problems of complex operation, long detection time, low operation efficiency and wound of patients exist, and a series of defects of poor compliance of patients, easy pollution of samples, low accuracy of detection results and the like can be caused, so the manual detection mode is clinically eliminated.
Disclosure of Invention
The invention mainly solves the technical problems that: how to overcome the defects existing in the prior EHBF detection, and the use experience of a user on the detection equipment is improved by providing various detection means. In order to solve the technical problems, the application provides a detection method and a detection device for effective liver blood flow and a storage medium.
According to a first aspect, an embodiment provides a method of detecting effective hepatic blood flow, comprising the steps of: acquiring spectroscopic detection data of the probe; the light splitting detection data comprises the transmittance of first-class wavelength detection light and second-class wavelength detection light which respectively penetrate through the detected part of the human body after the ICG elimination test is started; calculating to obtain the ICG real-time concentration and the ICG clearing rate in the human blood according to the light splitting detection data; calculating the circulating blood volume of the human body according to the ICG dosage in the ICG elimination test and the ICG real-time concentration; analyzing the product of the circulating blood volume and the ICG clearance rate to obtain the effective liver blood flow of the human body; the effective hepatic blood flow is used to characterize the effective state of hepatic blood perfusion and hepatocyte metabolism.
The calculating to obtain the ICG real-time concentration and the ICG clearing rate in the human blood according to the light splitting detection data comprises the following steps: inputting the spectroscopic detection data into a preset detection model, and calculating to obtain the ICG real-time concentration in the human blood; the detection model comprises a transmittance ratio of two types of wavelength detection light which respectively passes through the detected part of the human body, ICG real-time concentration, hemoglobin concentration and a function relation between propagation influence factors of the detected part of the human body to each type of detection light; determining the average ICG passing time in blood according to the ICG real-time concentration and expressing the average ICG passing time as MTT, expressing the ICG real-time concentration by using semilogarithmic coordinates in a period of time after the MTT, and obtaining the slope of a straight line of the concentration through linear regression analysis and using the slope as the ICG clearance rate in the human body.
The method for calculating the circulating blood volume of the human body according to the ICG dosage and the ICG real-time concentration in the ICG clearance test comprises the following steps: taking the concentration obtained by linear regression analysis determined at the mean time MTT as the initial concentration of ICG; calculating the circulating blood volume of the human body by using the dosage of ICG in the ICG clearance test and the initial concentration of the ICG, wherein the circulating blood volume is expressed by BV-I/C0(ii) a Wherein I is the dosage of ICG and C0At the initial ICG concentration.
The method for calculating the circulating blood volume of the human body according to the ICG dosage and the ICG real-time concentration in the ICG clearance test comprises the following steps: generating a pigment concentration graph under a semilogarithmic coordinate according to the ICG real-time concentration, and determining an AUC area in the pigment concentration graph; calculating the circulating blood volume of the human body by using the dosage of ICG in the ICG clearance test and the AUC area, and the circulating blood volume is expressed by the formula BV-I/(S)AUCX K); wherein I is the dosage of ICG and SAUCThe AUC area, K is the ICG clearance rate.
The generating of the pigment concentration graph under the semilog coordinate according to the ICG real-time concentration and the determining of the AUC area in the pigment concentration graph comprise: expressing the ICG real-time concentration under a semilogarithmic coordinate and generating a pigment concentration curve, and performing linear regression analysis on the pigment concentration curve within a period of time after MTT to obtain a regression line; the area of the quadrant enclosure of the regression line was excluded from the area of the quadrant enclosure before MTT, thereby obtaining the AUC area.
The analysis of the product of the circulating blood volume and the ICG clearance rate to obtain the effective liver blood flow of the human body comprises the following steps: calculating the product of the circulating blood volume and the ICG clearance rate, analyzing to obtain the effective liver blood flow, and expressing the effective liver blood flow as the formula of EHBF (BV multiplied by K); wherein BV is circulating blood volume and K is ICG clearance rate; if the circulating blood volume is expressed as BV ═ I/(S)AUCxK), the effective hepatic blood flow is reformulated as
EHBF＝I/SAUC。
According to a second aspect, an embodiment provides a device for detecting effective hepatic blood flow, comprising a probe, a detector, and a display; the probe is used for clamping a human body examined part and measuring corresponding transmittance when the detection light with the first type of wavelength, the detection light with the second type of wavelength and the detection light with the third type of wavelength respectively pass through the human body examined part; the detector is connected with the probe and used for calculating the effective liver blood flow of the human body according to the detection method in the first aspect; the display is connected to the detector for displaying the ICG real-time concentration, the ICG clearance rate and/or the effective hepatic blood flow.
The detector comprises: the acquisition module is used for acquiring the spectroscopic detection data of the probe; the light splitting detection data comprises the transmittance of first-class wavelength detection light and second-class wavelength detection light which respectively penetrate through the detected part of the human body after the ICG elimination test is started; the first calculation module is connected with the acquisition module and used for calculating the ICG real-time concentration and the ICG removal rate in the human blood according to the light splitting detection data; the second calculation module is connected with the first detection module and used for calculating the circulating blood volume of the human body according to the ICG dosage in the ICG elimination test and the ICG real-time concentration; the analysis module is connected with the first calculation module and the second calculation module and used for analyzing and obtaining the effective liver blood flow of the human body by utilizing the product of the circulating blood volume and the ICG clearance rate; the effective hepatic blood flow is used to characterize the effective state of hepatic blood perfusion and hepatocyte metabolism.
According to a third aspect, an embodiment provides a device for detecting effective hepatic blood flow, comprising: a memory for storing a program; and a processor, connected to the memory, for implementing the detection method according to the first aspect according to a program stored in the memory.
According to a fourth aspect, an embodiment provides a computer-readable storage medium, characterized by a program, which is executable by a processor to implement the detection method described in the first aspect above.
The beneficial effect of this application is:
according to the embodiment, the detection method, the detection device and the storage medium for the effective liver blood flow comprise the following steps: acquiring spectroscopic detection data of the probe, wherein the spectroscopic detection data comprises the transmittance of first-class wavelength detection light and second-class wavelength detection light which respectively penetrate through a detected part of a human body after an ICG elimination test is started; calculating to obtain the ICG real-time concentration and the ICG clearing rate in the human blood according to the light splitting detection data; calculating the circulating blood volume of the human body according to the ICG dosage and the ICG real-time concentration in the ICG elimination test; the product of the circulating blood volume and the ICG clearance rate is used for analyzing to obtain the effective liver blood flow of the human body. On the first hand, the ICG real-time concentration and the ICG removal rate in the blood of the human body are calculated according to the light splitting detection data, so that the detection process of an ICG removal test is greatly simplified, and the ICG removal test method has the advantages of no wound of a patient and strong real-time concentration detection performance; in the second aspect, the circulating blood volume of the human body is calculated according to the ICG dosage and the ICG real-time concentration in the ICG elimination test, so that the detection mode of the circulating blood flow is simplified, the defects of the existing in-vitro detection method using radioactive substances are avoided, and the function of synchronously determining the K value and the BV value in the ICG elimination test is favorably realized; in the third aspect, the product of the circulating blood volume and the ICG clearance rate is used for analyzing to obtain the effective liver blood flow of the human body, so that a reliable analysis mode of the effective liver blood flow is provided, the detection function of the system is enriched, and the convenience of the system use is improved; in a fourth aspect, the technical scheme simplifies the measurement formula of the EHBF to a certain extent, avoids calculation errors possibly caused by some calculation parameters, and is beneficial to improving the accuracy of EHBF detection, so that the reference value of the EHBF index in clinical application is enhanced; in the fifth aspect, the technical scheme innovatively detects the concentration of indocyanine green injected into a body in real time by a pulse densitometry, synchronously measures the ICG clearance rate and the circulating blood volume, and then calculates the EHBF index, thereby providing a reliable solution for monitoring the EHBF index only by one-time measurement in clinical at present.
Drawings
FIG. 1 is a schematic diagram of the structure of the device for detecting effective hepatic blood flow in the present application;
FIG. 2 is a schematic view of the probe;
FIG. 3 is a schematic diagram of a detector configuration;
FIG. 4 is a flow chart of a method for detecting effective hepatic blood flow in accordance with the present application;
FIG. 5 is a flow chart for obtaining ICG real-time concentration and ICG clearance rate;
FIG. 6 is a flow chart of calculating a circulating blood volume of a human in one embodiment;
FIG. 7 is a flow chart of calculating the circulating blood volume of a human body in another embodiment;
FIG. 8 is a schematic diagram of the determination of the mean transit time MTT;
FIG. 9 is a schematic diagram of the calculation of ICG clearance rate in a human;
FIG. 10 is a schematic diagram of the principle of determining the AUC area in semi-logarithmic coordinates;
FIG. 11 is a schematic diagram of the structure of an apparatus for detecting effective hepatic blood flow in another embodiment of the present application.
Detailed Description
The present invention will be described in further detail with reference to the following detailed description and accompanying drawings. Wherein like elements in different embodiments are numbered with like associated elements. In the following description, numerous details are set forth in order to provide a better understanding of the present application. However, those skilled in the art will readily recognize that some of the features may be omitted or replaced with other elements, materials, methods in different instances. In some instances, certain operations related to the present application have not been shown or described in detail in order to avoid obscuring the core of the present application from excessive description, and it is not necessary for those skilled in the art to describe these operations in detail, so that they may be fully understood from the description in the specification and the general knowledge in the art.
Furthermore, the features, operations, or characteristics described in the specification may be combined in any suitable manner to form various embodiments. Also, the various steps or actions in the method descriptions may be transposed or transposed in order, as will be apparent to one of ordinary skill in the art. Thus, the various sequences in the specification and drawings are for the purpose of describing certain embodiments only and are not intended to imply a required sequence unless otherwise indicated where such sequence must be followed.
The numbering of the components as such, e.g., "first", "second", etc., is used herein only to distinguish the objects as described, and does not have any sequential or technical meaning. The term "connected" and "coupled" when used in this application, unless otherwise indicated, includes both direct and indirect connections (couplings).
For clarity of understanding of the technical aspects of the present application, some terms will be described herein.
Effective liver function, which is the sum of all liver parenchymal cell functions that the subject has in health, reflects the physiologically effective state of the liver in terms of intake, metabolism, synthesis, biotransformation, and excretion. Under the pathological condition that the liver is damaged, the effective liver function needs to meet the functional requirements of organism metabolism, immunity, detoxification and the like, and also needs to meet the requirements of liver self tissue repair and regeneration; effective liver function then essentially determines the strength of an individual's ability to rehabilitate and the ability of the liver to withstand the impact of various external stimuli or diagnostic activities themselves. In general, the major contributors to effective liver function include the amount of functional hepatocytes and the necessary hepatic perfusion.
Effective liver Blood Flow (EHBF) refers to liver Blood Flow which is in contact with liver cells to play a metabolic function, reflects the change of liver Blood perfusion and cell metabolism conditions, and is a sensitive index for evaluating whether liver region perfusion and metabolism are Effective or not.
Indocyanine green (ICG for short) is a common dye indicator medicament in clinic, has the characteristics of no toxicity, no side effect on cardiovascular system and rapid combination with plasma protein, can be rapidly distributed to various circulating organs of a human body after being injected into an ICG solution, and is discharged by self circulation of liver cells. Only 3% of the blood remains in normal persons after 20 minutes of ICG solution injection, so that the examination can be carried out for a plurality of times at reasonable time intervals. Therefore, in an indocyanine green clearance test, parameters such as real-time concentration and retention rate of indocyanine green can reflect the state of effective liver function.
The technical solution of the present application will be specifically described with reference to the following examples.
The first embodiment,
Referring to fig. 1, the present application discloses a device for detecting effective hepatic blood flow, which comprises a probe 11, a detector 12 and a display 13, which are described below.
The probe 11 is used for clamping a detected part of a human body and has the functions of transmitting and receiving various types of detection light. In this embodiment, the probe 11 measures the corresponding transmittance when the detection light with the first type of wavelength, the detection light with the second type of wavelength, and the detection light with the third type of wavelength respectively pass through the examined part of the human body.
It should be noted that, in order to measure the absorption of hemoglobin, indocyanine green (ICG), etc. in blood to the detection light, a body part with a small tissue layer thickness and rich blood vessels in the tissue should be selected as the examined body part of the human body, such as a body part of a finger, a toe, a wing of the nose, an earlobe, etc., so that the use condition of the probe that the probe is easy to clamp and the detection light easily passes through can be satisfied.
The detector 12 is connected with the probe 11, and the detector 12 is mainly used for acquiring a detection signal from the probe 11 and calculating the ICG real-time concentration, the ICG clearance rate, the circulating blood volume and/or the effective liver blood flow in the human body according to an algorithm set by an internal program.
It should be noted that the detector 12 may be a medical detection device with electronic circuit and implementing specific functions, and can perform real-time recording and automatic processing analysis on the detection signal from the probe 11, so as to obtain the relevant detection data of the human body in the ICG clearance test.
A display 13 is connected to the detector 12, and the display 12 is mainly used for displaying the processing result (such as ICG real-time concentration, ICG clearance rate, circulating blood volume and/or effective liver blood flow) of the detector 12 for the convenience of medical staff or for viewing.
It should be noted that the display 13 may be a conventional CRT display, LCD display, LED display, and the content or graphic layout of the display itself may be configured according to actual needs, and is not limited herein. In addition, the display 13 may also have color rendering capabilities and touch operation capabilities to provide a better use experience for the user.
In the present embodiment, referring to fig. 1 and 2, the probe 11 includes a transmitter 111, a receiver 112, and a cable 113. Wherein, the emitter 111 and the receiver 112 are oppositely arranged, and a clamping area for clamping the human body detected part P1 (such as a finger) is arranged in the middle; the transmitter 111 and the receiver 112 are both connected to a cable 113, and the cable 113 is used for connecting to the detector 12 and plays a role of signal transmission. The emitter 111 has an emission capability of a plurality of types of detection light (e.g., detection light L1, L2, L3), while the receiver 112 has a reception capability of each type of detection light. For a certain type of detected light, if the intensity of incident light I emitted by the emitter 111 is known0When the intensity I of the outgoing light received by the receiver 112 is equal to the intensity of the outgoing light, the transmittance a of the detected light can be calculated as log (I/I)0)。
It should be noted that the detection light L1 with the first type of wavelength may have λ1Where the wavelength is 805 ± 20nm, the second wavelength L2 may have a wavelength λ2The third type of wavelength of the detection light L3 may have λ, where λ is 940 ± 20nm3660 ± 20 nm.
In the present embodiment, referring to fig. 1 and 3, the detector 12 includes an acquisition module 121, a first calculation module 122, a second calculation module 123, and an analysis module 124, which are respectively described below.
The acquiring module 121 is configured to acquire spectroscopic measurement data of the probe 11, where the spectroscopic measurement data includes transmittances of the detection light L1 with the first type of wavelength and the detection light L2 with the second type of wavelength, respectively, passing through the examined region of the human body after the ICG clearance test is started.
The first calculating module 122 is connected to the obtaining module 121, and is configured to calculate an ICG real-time concentration and an ICG removal rate in human blood according to the spectroscopic detection data.
The second calculating module 123 is connected to the first detecting module 122, and is configured to calculate the circulating blood volume of the human body according to the ICG dosage and the ICG real-time concentration in the ICG clearance test.
The analysis module 124 is connected to the first calculation module 122 and the second calculation module 123, and is used for analyzing the product of the circulating blood volume and the ICG clearance rate to obtain the effective liver blood flow of the human body.
It is noted that the analysis module 124 analyzes the obtained effective hepatic blood flow to characterize the effective state of hepatic blood perfusion and hepatocyte metabolism. Further, the real-time ICG concentration may be in mg/L, the ICG clearance rate may be in%/min, the circulating blood volume may be in L (liters), and the effective hepatic blood flow may be in L/min.
In this embodiment, referring to fig. 1, after the probe 11 is held on the finger or the nasal ala of the human body and connected to the detector 12 by a cable, the ICG clearance test can be performed on the human body P0. Here, it is necessary to inject physiological saline or glucose solution mixed with ICG solution into the human body's meridians using the syringe 14, and it is considered that ICG clearance test starts while the syringe 14 advances, after which indocyanine green (ICG) diffuses in the blood through the veins and finally disappears by the clearance of the liver.
It can be understood that, after the ICG clearance test is started, the detector 12 can obtain the light intensity collected by the probe 11 in real time, calculate the ICG real-time concentration in the blood of the human body by using a preset detection model, and further analyze and obtain the effective liver blood flow of the human body. The function of the detector 12 will be specifically described in embodiment two below.
Those skilled in the art can understand that the technical scheme innovatively detects the concentration of indocyanine green injected into a body in real time through a pulse densitometry, synchronously measures the ICG clearance rate and the circulating blood volume, then calculates the effective liver blood flow (namely EHBF), and provides a reliable solution for monitoring the EHBF index only through one-time measurement in clinical practice at present.
Example II,
Referring to fig. 4, the present embodiment discloses a method for detecting effective hepatic blood flow, which includes steps S210-S240, which are described below.
Step S210, acquiring the spectroscopic detection data of the probe. The spectroscopic measurement data herein includes transmittances of the first type wavelength of the detection light and the second type wavelength of the detection light, respectively, through the examined region of the human body after the ICG clearance test is started.
For example, referring to fig. 1, after the ICG clearing test is started, the detector 12 controls the probe 11 to continuously emit the detecting light L1 with the first type of wavelength and the detecting light L2 with the second type of wavelength at a certain period, and then the detector 12 receives the light intensity signal fed back by the probe 11, so that the processed detecting light L1 with the first type of wavelength passes through the transmittance of the examined part of the human body, and is denoted by a'8(ii) a At the same time, the transmittance of detecting light L2 with the second wavelength passing through the detected part of human body is obtained, and is A'9。
And step S220, calculating to obtain the ICG real-time concentration and the ICG clearing rate in the human blood according to the light splitting detection data.
In order to calculate the ICG real-time concentration in the human blood, a detection model about the ICG real-time concentration can be established, and the detection light with the first wavelength and the detection light with the second wavelength in the spectroscopic detection data respectively penetrate through the light transmittance (such as A ') of the detected part of the human body'8、A′9) Input to the detection model to output the ICG real-time concentration.
To calculate the ICG clearance rate, linear regression analysis of the ICG real-time concentration at semi-logarithmic scale was performed to obtain the ICG clearance rate in humans. For example, the ICG real-time concentration is expressed by a semilog coordinate in a set concentration analysis interval, the slope of a straight line of the concentration is obtained by linear regression analysis, and the slope of the straight line is used as the ICG clearance rate in the human body.
And step S230, calculating the circulating blood volume of the human body according to the ICG dosage and the ICG real-time concentration in the ICG elimination test.
The dosage of indocyanine green (ICG) is directly related to the weight of a human body, and is in positive correlation with the weight of the human body according to the metabolism condition of the ICG in the human body, and the dosage of indocyanine green (ICG) per kilogram of the human body is 0.01-5 mg. The actual dosage of the ICG is often determined before the ICG clearance test is carried out, so that the dosage of the ICG in the ICG clearance test is a fixed value for an individual and only needs to be read when calculating the circulating blood volume of the human body.
Step S240, the product of the circulating blood volume and the ICG clearance rate is used for analyzing to obtain the effective liver blood flow of the human body. The effective hepatic blood flow is used herein to characterize the perfusion of the hepatic blood flow and the effective state of the metabolism of the hepatocytes.
In the present embodiment, referring to fig. 5, the above step S220 mainly relates to the process of calculating the real-time ICG concentration and ICG clearance rate in human blood, and the step S220 may specifically include steps S221-S222, which are respectively described as follows.
And step S221, inputting the spectroscopic detection data into a preset detection model, and calculating to obtain the ICG real-time concentration in the human blood. The detection model comprises the transmittance ratio of the detection light with two types of wavelengths passing through the detected part of the human body, the ICG real-time concentration, the hemoglobin concentration and the function relationship between the propagation influence factors of the detected part of the human body to each type of detection light.
To help the skilled person understand the construction process of the detection model, the following description will explain the construction principle of the detection model.
Acquiring a set of spectroscopic test data of the probe by spectroscopic test, the set of emission test data including transmittances of the first type wavelength (L1), the second type wavelength (L2) and the third type wavelength (L3) of the test light respectively penetrating through the examined part of the human body before the ICG clearance test is started, and the transmittances corresponding to the three types of wavelength of the test light can be respectively expressed as A8、A9、A6Wherein the subscripts 8, 9, 6 are the first type of wavelength, the second type of wavelength, and the third type of wavelength, respectivelyA long logo. Transmittance A8、A9、A6Is a parameter obtained according to the Lambert-beer law expressed as
Wherein A is absorbance, emergent light intensity I and incident light intensity I0The comparison ratio of (a); k is a molar absorption coefficient and is related to the nature of the absorbing substance and the wavelength lambda of the detected light; c is the concentration of the light absorbing substance, and the unit is mol/L; b is the thickness of the absorbing layer in cm.
According to the principle of indicator dilution, ICG is injected into the body and then rapidly combined with plasma protein, if blood is taken as a light transmission medium, then a light absorption substance in the ICG also comprises indocyanine green (i.e. ICG) besides hemoglobin (i.e. Hb), and then the absorbance A is expressed again as
Wherein, Kh、KiThe absorbance of Hb and ICG in blood, Ch、CiThe concentrations of Hb and ICG in blood, respectively. During the propagation of the detecting light, the blood vessel will contract and expand with the pulse of the pulse, and when the change causes the propagation distance of the detecting light in the blood to increase by Δ b, the intensity of the emitted light will decrease by Δ I, and the light density will also generate the change of Δ a. Then, when the amount of change in light caused by the pulse is Δ I, Δ a can be formulated as
If the light is detected in two different types of wavelengths (e.g. wavelength λ)1And the detection light L1 and the wavelength is lambda2Detected light L2) are measured, two sets of different variations Δ a of optical density can be obtained respectively6And Δ A8Then, the influence of Δ b can be eliminated and the ratio of the pulsating amount of blood in the case where any two types of detection light are transmitted can be obtained, for example, the ratio of the pulsating amount of blood in the case where the detection light of the first type wavelength L1 and the detection light of the second type wavelength L2 are transmitted is expressed as
Only the influence of Hb and ICG on the pulsating mass ratio is considered here, provided that no dispersion of the detection light in the homogeneous medium occurs. However, for the finger tip skin, both the blood-induced dispersion and the effect of the peripheral tissue are not negligible, and if these two factors are taken into account, Δ a will be re-expressed as
Where F is the scattering coefficient of blood (usually considered as a constant), Δ bbRepresenting the variation of the distance traveled by the light in the blood due to arterial blood pulsation, ZtΔ b is the attenuation coefficient of light in tissuetIndicating that the pulse beat causes a change in the distance traveled by the detected light in the tissue.
At this time, the ratio of the pulsating amount of blood when the detection light of the first type wavelength L1 and the detection light of the second type wavelength L2 are transmitted is newly expressed as
Wherein, KiAbsorbance of ICG in blood for any kind of detected light,. DELTA.bbAmount of change in the propagation distance of the detected light in the blood, Z, caused by pulse beatingt8、Zt9The attenuation coefficients of the first detection light and the second detection light in the detected part of the human body, delta btThe amount of change in the propagation distance of the detection light due to the pulse beat in the human body. If propagation influence factor is used
The relation between the pulse volume ratio and hemoglobin, ICG real-time concentration and propagation influence factor can be obtained by simplifying the formula, and the formula of the pulse volume ratio is simplified and expressed as
Wherein E isx8＝Zt8Δbt/(ChΔbb)，Ex9＝Zt9Δbt/(ChΔbb). Before ICG elimination test, because the real-time concentration of ICG is zero, the formula can be further simplified, so that the pulsating quantity ratio of blood under the condition of any two kinds of detection light transmission can be obtained, and the formula can be parallelly connected to form a formula group
Due to the equation set
Are all quantities which can be calculated from the second spectroscopic detection data, then it is easy to calculate E by simultaneous equationsx6、Ex8、Ex9Thereby constructing a detection model
According to the detection model, the calculation is carried out according to the first spectrophotometric detection data after the ICG elimination test is started
The ICG real-time concentration C can be calculated with the knowledge of the other parameter valuesi. Note that the hemoglobin concentration C in the measurement modelhThe detection value is a preset standard value or an actual detection value, and is not limited herein.
It is understood that, in the spectroscopic measurement data, the transmittances of the first-type wavelength measurement light and the second-type wavelength measurement light passing through the examined region of the human body after the ICG clearance test is started are represented by A'8、A′9Then, the variation amount delta A 'of the transmittance of two adjacent times can be utilized'8、ΔA′9Substitution of Δ A in detection model8、ΔA9Then can be calculated
And knowing Kh8、Ki8、Kh9、Ki9、ChAnd F, the ICG real-time concentration C is easy to calculatei。
Step S222, determining the average passing time of the ICG in the blood according to the ICG real-time concentration and expressing the average passing time as MTT, expressing the ICG real-time concentration by using semilogarithmic coordinates in a period of time after the MTT, obtaining the slope of a straight line of the concentration through linear regression analysis and taking the slope as the ICG removing rate in the human body.
Referring to fig. 8, after ICG is injected into a human body, its initial circulation curve and the circulation curve in the same are shown as the curves in the figure as the blood is distributed throughout the body. Since the ICG real-time concentration is known, the time-of-drug curve of fig. 8 can be plotted, wherein the first circulation curve refers to the concentration profile of ICG during diffusion in the human blood and during clearance at the first clearance rate, and the recirculation curve refers to the concentration profile of ICG during clearance in the human blood at the second clearance rate. In the time curve of the drug administration, the first circulation curve is naturally extended to form a closed area, and the time corresponding to the position of the central line is defined as the average distribution time, namely MTT. Since MTT represents the time when ICG is uniformly distributed in blood, ICG is eliminated in blood at a first-order rate, and a certain time range after MTT is taken to generate a concentration analysis interval. For example, taking the interval range of 2.5-5.5min after MTT, the concentration analysis interval can be generated and expressed as MTT + 2.5-MTT +5.5, in min.
Referring to fig. 9, the real-time ICG concentration in the concentration analysis interval is represented by a semi-logarithmic coordinate, where the decay curve of the concentration forms an almost straight line, and the slope of the straight line with respect to the concentration is obtained by linear regression analysis, and the slope of the straight line is used as the ICG clearance rate in the human body. It should be noted that one axis of the semi-logarithmic coordinate system is a common coordinate axis with uniform graduation, and the other axis is a logarithmic coordinate axis with non-uniform graduation; since the semi-logarithmic coordinate system is a commonly used technical means in mathematical analysis, it will not be described here.
It can be understood that, in steps S221-S222 illustrated in fig. 5, the ICG real-time concentration and the ICG clearance rate in the blood of the human body are calculated according to the spectroscopic detection data, so that the detection process of the ICG clearance test can be greatly simplified, and the detection system has the advantages of no wound to the patient and strong real-time concentration detection performance.
In the present embodiment, referring to fig. 6, the step S230 mainly relates to a process of calculating the circulating blood volume of the human body, and specifically may include steps S231-S232, which are respectively described as follows.
In step S231, the concentration obtained by linear regression analysis determined by the mean time MTT is used as the ICG initial concentration. Since MTT represents the time when ICG is uniformly distributed in blood and then ICG is cleared in blood at a first-order rate, the concentration obtained by linear regression analysis determined at the MTT moment is used as the initial concentration of ICG, so that the clearance of ICG can be more easily represented in subsequent treatment.
Referring to fig. 9, a regression line with respect to concentration is obtained through linear regression analysis, and the MTT time on the abscissa axis corresponds to the H point on the regression line, and the concentration corresponding to the H point on the ordinate axis is the ICG initial concentration.
For example, the relationship between the relative concentration of ICG and the rate of ICG clearance is
And the relationship between the ICG absolute concentration and the hemoglobin concentration is
Wherein, CICG(t)ICG real-time concentration at MTT + t, C0The ICG real-time concentration at the MTT +0 moment, and K is the ICG clearance rate; a. theICGIs the absorbance of ICG, AHbIs the absorbance of Hb, CICGIs the ICG concentration, CHbHb concentration, f is the ratio of the absorption coefficients of ICG and hemoglobin.
Combining the above relational formula, the method can obtain
At this time, it is only necessary to know the ICG real-time concentration at MTT +0, i.e., CICG(0)The initial concentration of ICG is shown, so that the subsequent real-time concentration of ICG can be known, and the clearance of ICG is shown.
Step S232, calculating the circulating blood volume of the human body by using the dosage of ICG in the ICG elimination test and the initial concentration of ICG, and expressing the circulating blood volume as formula
BV＝I/C0。
Wherein I is the dosage of ICG and C0At the initial ICG concentration. The circulating blood volume, expressed by BV, is the amount of blood needed to satisfy the effective perfusion of the organs of the body under normal blood pressure conditions, expressed in L/min.
It should be noted that steps S231-S232 disclosed in fig. 6 may be referred to as an extrapolation method for measuring the circulating Blood Volume (BV), where I is a known quantity,only need to mix C0The circulation blood volume can be calculated by substituting into a formula, and the purpose of measuring the BV value is achieved.
In this example, another method of measuring circulating Blood Volume (BV) is provided, which may be referred to as the AUC method, which calculates BV primarily by the area of the pigment concentration map. Since the ICG real-time concentration can be expressed as CICG(t)＝C0×e(-Kt)So as to be easily integrated
∫C(t)dt＝{C0×e(-Kt)}/(-K)；
Then calculating the area AUC under the pigment concentration curve over a time period of 0 to infinity can convert the above equation to
SAUC＝C0/K；
At this time, the circulating blood volume is formulated as BV ═ I/(S)AUC×K)。
Referring to fig. 7, based on the AUC method, step S230 may specifically include steps S233-S234, which are respectively described as follows.
And step S233, generating a pigment concentration graph under a semilog coordinate according to the ICG real-time concentration, and determining the AUC area in the pigment concentration graph.
In one embodiment, referring to FIG. 10, the ICG real-time concentration is represented in a semi-logarithmic scale and a pigment concentration curve l is generated1By means of a curve l of the concentration of the dye over a period of time after MTT (e.g. a time range of 2.5-5.5min after MTT)1Linear regression analysis is carried out to obtain a regression line l2(ii) a Then, the pigment concentration curve l is used1And a regression line l2A dye concentration map in a semilogarithmic coordinate is generated. After that, on the regression line l2The area of the quadrant enclosure before MTT was removed to obtain the AUC area.
In fig. 10, the area of the first cycle curve is subtracted from the area of the dye concentration map, and the remaining area is defined as the AUC area. If it is S1The area remaining after subtracting the first cycle area from the dye concentration map at the end of the regression interval is represented by S2Surface estimated from the end of regression interval to infinite timeProduct, then AUC area will be formulated as
SAUC＝S1+S2。
Step S234, calculating the circulating blood volume of the human body by using the ICG dosage and the AUC area in the ICG elimination test, and expressing the circulating blood volume as formula
BV＝I/(SAUC×K)；
Wherein I is the dosage of ICG and SAUCThe AUC area, K is the ICG clearance rate.
It should be noted that, since it is verified that the extrapolation method shown in steps S231 to S232 and the AUC method shown in steps S233 to S234 are substantially the same in calculation result of the circulating blood volume based on the clinical actual test data, the specific method is not limited. In addition, the technical personnel can understand that the circulating blood volume of the human body is calculated according to the dosage of ICG and the ICG real-time concentration in the ICG elimination test, so that the detection mode of the circulating blood volume is simplified, the defects of the existing in-vitro detection method using radioactive substances are avoided, and the function of synchronously determining the K value and the BV value in the ICG elimination test is favorably realized.
In the present embodiment, step S240 mainly involves a process of analyzing and obtaining effective hepatic blood flow of the human body, which may be specifically described as: calculating the product of the circulating blood volume and the ICG clearance rate, analyzing to obtain the effective liver blood flow and expressing the effective liver blood flow as the formula
EHBF＝BV×K；
Where BV is circulating blood volume and K is ICG clearance rate.
In one embodiment, if the circulating blood volume is determined by extrapolation and is expressed as BV ═ I/C0Then the effective liver blood flow is re-formulated as EHBF ═ I × K/C0。
In one embodiment, if the circulating blood volume is measured by the AUC method and is expressed as BV ═ I/(S)AUCX K), the effective liver blood flow is reformulated as
It will be understood by those skilled in the art that EHBF based on AUC is related only to the amount of I, AUC area in ICG administered, but not to the initial concentration C0Irrelevant, the initial concentration C is avoided0The influence on the calculation result is beneficial to improving the calculation accuracy. In addition, the technical scheme provided in this embodiment has simplified the measurement formula of EHBF to a certain extent, has not only avoided the calculation error that some calculation parameters probably arouse, still is favorable to promoting the precision that EHBF detected to strengthen the reference value of EHBF index in clinical application.
Example III,
Referring to fig. 11, the present embodiment discloses a device for detecting effective hepatic blood flow, which includes a memory 21 and a processor 22.
The memory 21 is used to store the program, the memory 21 can be regarded as a computer-readable storage medium, and the program stored inside can be a software code corresponding to the detection method in the second embodiment.
The processor 22 is connected to the memory 21, and is configured to execute the program stored in the memory 21 and implement the detection method disclosed in the second embodiment.
Those skilled in the art will appreciate that all or part of the functions of the various methods in the above embodiments may be implemented by hardware, or may be implemented by computer programs. When all or part of the functions of the above embodiments are implemented by a computer program, the program may be stored in a computer-readable storage medium, and the storage medium may include: a read only memory, a random access memory, a magnetic disk, an optical disk, a hard disk, etc., and the program is executed by a computer to realize the above functions. For example, the program may be stored in a memory of the device, and when the program in the memory is executed by the processor, all or part of the functions described above may be implemented. In addition, when all or part of the functions in the above embodiments are implemented by a computer program, the program may be stored in a storage medium such as a server, another computer, a magnetic disk, an optical disk, a flash disk, or a removable hard disk, and may be downloaded or copied to a memory of a local device, or may be version-updated in a system of the local device, and when the program in the memory is executed by a processor, all or part of the functions in the above embodiments may be implemented.
The present invention has been described in terms of specific examples, which are provided to aid understanding of the invention and are not intended to be limiting. For a person skilled in the art to which the invention pertains, several simple deductions, modifications or substitutions may be made according to the idea of the invention.
Claims (10)
1. A method for detecting effective hepatic blood flow, comprising the steps of:
acquiring spectroscopic detection data of the probe; the light splitting detection data comprises the transmittance of first-class wavelength detection light and second-class wavelength detection light which respectively penetrate through the detected part of the human body after the ICG elimination test is started;
calculating to obtain the ICG real-time concentration and the ICG clearing rate in the human blood according to the light splitting detection data;
calculating the circulating blood volume of the human body according to the ICG dosage in the ICG elimination test and the ICG real-time concentration;
analyzing the product of the circulating blood volume and the ICG clearance rate to obtain the effective liver blood flow of the human body; the effective hepatic blood flow is used to characterize the effective state of hepatic blood perfusion and hepatocyte metabolism.
2. The method of claim 1, wherein said calculating the real-time ICG concentration and ICG clearance rate in the blood of the human based on said spectroscopic measurement data comprises:
inputting the spectroscopic detection data into a preset detection model, and calculating to obtain the ICG real-time concentration in the human blood; the detection model comprises a transmittance ratio of two types of wavelength detection light which respectively passes through the detected part of the human body, ICG real-time concentration, hemoglobin concentration and a function relation between propagation influence factors of the detected part of the human body to each type of detection light;
determining the average ICG passing time in blood according to the ICG real-time concentration and expressing the average ICG passing time as MTT, expressing the ICG real-time concentration by using semilogarithmic coordinates in a period of time after the MTT, and obtaining the slope of a straight line of the concentration through linear regression analysis and using the slope as the ICG clearance rate in the human body.
3. The test method of claim 2, wherein calculating the circulating blood volume of the human based on the ICG dosage in the ICG clearance test and the ICG real-time concentration comprises:
taking the concentration obtained by linear regression analysis determined at the mean time MTT as the initial concentration of ICG;
calculating the circulating blood volume of the human body by using the dosage of ICG in the ICG clearance test and the initial concentration of the ICG, wherein the circulating blood volume is expressed by a formula
BV＝I/C0；
Wherein I is the dosage of ICG and C0At the initial ICG concentration.
4. The test method of claim 2, wherein calculating the circulating blood volume of the human based on the ICG dosage in the ICG clearance test and the ICG real-time concentration comprises:
generating a pigment concentration graph under a semilogarithmic coordinate according to the ICG real-time concentration, and determining an AUC area in the pigment concentration graph;
calculating the circulating blood volume of the human body by using the dosage of ICG in the ICG clearance test and the AUC area, and expressing the circulating blood volume as
BV＝I/(SAUC×K)；
Wherein I is the dosage of ICG and SAUCThe AUC area, K is the ICG clearance rate.
5. The detection method of claim 4, wherein said generating a pigment concentration map in semi-logarithmic coordinates from said ICG real-time concentration, and determining an AUC area in said pigment concentration map, comprises:
expressing the ICG real-time concentration under a semilogarithmic coordinate and generating a pigment concentration curve, and performing linear regression analysis on the pigment concentration curve within a period of time after MTT to obtain a regression line;
the area of the quadrant enclosure of the regression line was excluded from the area of the quadrant enclosure before MTT, thereby obtaining the AUC area.
6. The method of detecting according to any of claims 1-5, wherein said analyzing the product of said circulating blood volume and said ICG clearance rate to obtain an effective hepatic blood flow of the human comprises:
calculating the product of the circulating blood volume and the ICG clearance rate, analyzing to obtain the effective liver blood flow, and formulating into formula
EHBF＝BV×K；
Wherein BV is circulating blood volume and K is ICG clearance rate;
if the circulating blood volume is expressed as BV ═ I/(S)AUCxK), the effective hepatic blood flow is reformulated as
EHBF＝I/SAUC。
7. A device for detecting effective hepatic blood flow is characterized by comprising a probe, a detector and a display;
the probe is used for clamping a human body examined part and measuring corresponding transmittance when the detection light with the first type of wavelength, the detection light with the second type of wavelength and the detection light with the third type of wavelength respectively pass through the human body examined part;
the detector is connected with the probe and used for calculating the effective hepatic blood flow of the human body according to the detection method of any one of claims 1 to 6;
the display is connected to the detector for displaying the ICG real-time concentration, the ICG clearance rate and/or the effective hepatic blood flow.
8. The detection apparatus of claim 7, wherein the detector comprises:
the acquisition module is used for acquiring the spectroscopic detection data of the probe; the light splitting detection data comprises the transmittance of first-class wavelength detection light and second-class wavelength detection light which respectively penetrate through the detected part of the human body after the ICG elimination test is started;
the first calculation module is connected with the acquisition module and used for calculating the ICG real-time concentration and the ICG removal rate in the human blood according to the light splitting detection data;
the second calculation module is connected with the first detection module and used for calculating the circulating blood volume of the human body according to the ICG dosage in the ICG elimination test and the ICG real-time concentration;
the analysis module is connected with the first calculation module and the second calculation module and used for analyzing and obtaining the effective liver blood flow of the human body by utilizing the product of the circulating blood volume and the ICG clearance rate; the effective hepatic blood flow is used to characterize the effective state of hepatic blood perfusion and hepatocyte metabolism.
9. A device for detecting effective hepatic blood flow, comprising:
a memory for storing a program;
a processor coupled to the memory for implementing the detection method of any one of claims 1-6 according to a program stored in the memory.
10. A computer-readable storage medium, characterized by comprising a program executable by a processor to implement the detection method according to any one of claims 1 to 6.
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