术前肝功能评价在肝癌肝移植预后判断中的价值  

Predicting value of preoperative liver function evaluation for prognosis of liver transplantation for hepatocellular carcinoma

作　　者：徐泱[1] 樊嘉[1] 周俭[1] 邱双健[1] 吴志全[1] 余耀[1] 黄晓武[1] 汤钊猷[1] 王玉琦[1] 

机构地区：[1]上海复旦大学附属中山医院肝外科,复旦大学肝癌研究所,200032

出　　处：《中华肝胆外科杂志》2008年第1期3-5,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：本课题受国家自然科学基金（基金编码30500594）;上海市科委重点项目基金（基金编码024119001）资助

摘　　要：目的评估各种术前肝功能评价系统及指标在肝癌肝移植预后判断中的价值。方法回顾性分析上海中山医院近5年来289例肝癌肝移植病例，Kaplan-Meier生存率统计分析术前Child—Pugh—Turcotte（cPT）分级、MELD（终末期肝病模型）评分及其他肝功能指标如总胆红素、INR、肌酐、白蛋白、前白蛋白、总胆汁酸与肝癌肝移植术后生存率及无瘤生存率的相关性。结果术前不同CPT分级、MELD评分、血清总胆红素、INR、肌酐及白蛋白水平间在肝癌肝移植术后生存率及无瘤生存率上无显著性差异（P〉0.05），而术前血清总胆汁酸（P=0．001）及前白蛋白水平（P=0．034）与肝癌肝移植术后生存率显著相关。结论术前CPT分级及MELD评分系统不能作为肝癌肝移植预后判断的依据和术前病例筛选的指标；术前血清总胆汁酸〉100μmol／L和（或）前白蛋白〈0．18mg／dl是肝癌肝移植危险因素，提示预后不良。Objective To determine the predicting value of preoperative liver function evaluation for the prognosis of liver transplantation （LT） for hepatocellular carcinoma （HCC） . Methods A retrospective analysis was performed on 289 consecutive patients with HCC who underwent LT between April 2001 and January 2006 at our institution. The 1, 2, and 3-year survival rate and tumor-free survival rate were estimated by means of Kaplan Meier method. A univariate analysis was performed to determine different variables for liver function evaluation by means of the Logrank test. Results There was no significant difference in survival rate between different groups of Child-Pugh-Turcotte （CPT）classification, model for end-stage liver disease （MELD） score and total bilirubin （TB）, creatinine （Cr）, albumen （ALB） and INR. The total bile acids （TBA） and prealbumin （PA） were significantly related to the post-LT survival rate. Conclusions CPT classification and MELD score have no predicting value for the prognosis of LT for HCC patients. The outcome is poor if a patient has serum TBA〉100 μmol/L and/ or PA〈0. 18 mg/dl.

关 键 词：肝移植 肝癌 生存率 Child—Pugh—Turcotte(CPT)分级 MELD评分 

分 类 号：R735.7[医药卫生—肿瘤]