Relationship of the Pharmacologic Effect of Colchicine and the Shunt Index of Tl-201 Liver Scintigraphy in Chronic Liver Disease

만성 간질환 환자에서 콜히친 약리효과와 Tl-201 간문맥 스캔 단락지수와의 관련성

Background : Recently some clinical studies suggest that the stage of the progression in chronic liver disease would be important for colchicine treatment and colchicine may prevent the progression of chronic liver disease, especially, severe chronic active hepatitis(CAH) and early cirrhotic patients. However, in all patient of chronic liver disease, it is very difficult to perform liver biopsy. To decide the stage of colchicine treatment and maximize the pharmacologic effect of colchicine in chronic liver disease, we evaluate the correlation of the effect of colchicine and the shunt index(SI) of TI-201 liver scan instead of liver biopsy. Method : We retrospectively analyzed the first and last laboratory test variables, including albumin, bilirubin, ALT, AST, cholesterol, prothrombin time, and SI, obtained from 131 patients ; 32 moderate CAH, 35 severe CAH, 64 LC (Child A), which were proven with percutaneou liver biopsy. All patients were followed up for more than 2 years and performed TI-201 liver scan and taked colchicine. After we obtained the mean shunt index in three groups and the based shunt index by means of ROC analysis, all patients were divided into two groups on the basis of each shunt indices. The two groups were compared with a change of X value ; the sum of the last X value minus the first X value. [$Z=3.3431-0.8160\;{\times}\;ALT/AST-0.0343\;{\times}\;PT+2.6963\;{\times}\;SI,\; X=e^z/(e^z+ 1)$, as the X value increases from 0 to 1, chronic active hepatitis will progress into liver cirrhosis] Results : Each shunt indices are $0.17\;{\pm}\;0.08$ in moderate CAH, $0.24\;{\pm}\;0.02$ in severe CAH, $0.45\;{\pm}\;0.04$ in LC. On the basis of 0.17, there was no statistical difference of a change of X value between $SI{\geq}0.17$ and SI<0.17 (p=0.09). On the other hand, on the basis of 0.24 and 0.45, there was statistical difference of a change of X value between two groups [$SI{\geq}0.24$ and<0.24 (p=0.011), $SI{\geq}0.45$ and<0.45 (p=0.001)]. We could notice an improvement in $SI{\geq}0.24$ and$SI{\geq}0.45$. Also on the basis of 0.19 which is a cut-point to divide the patients into two groups (moderate CAH vs severe CAH+LC), there was statistical difference of a change of X value between two groups [$SI{\geq}0.19$ and < 0.19 (p=0.012)]. Conclusion : On $SI{\geq}0.19$, colchicine has the effect to prevent progression of chronic liver disease. This results suggest that the SI of TI-201 liver scan may be useful for the evaluation of adequate time of colchicine treatment and prediction of the pharmacologic effect of colchicine.