非侵人性肝纤维化诊断模型对肝癌介入治疗后急性肝功能恶化的预测作用  

Non-invasive fibrosis indexes in predicting acute liver function deterioration after transcatheter arterial chemoembolization

作　　者：宋裕萍 赵擎宇[1] 李松[3] 王慧[1] 吴沛宏[2] 

机构地区：[1]中山大学肿瘤防治中心华南肿瘤学国家重点实验室重症医学科,广州510060 [2]中山大学肿瘤防治中心华南肿瘤学国家重点实验室微创介入科,广州510060 [3]中山大学中山医学院临床医学系

出　　处：《中华医学杂志》2016年第9期716-719,共4页National Medical Journal of China

摘　　要：目的研究在接受经导管动脉化疗栓塞（TACE）的原发性肝细胞癌（HCC）患者中，两种非侵入性肝纤维化诊断模型，天冬氨酸转氨酶与血小板比值（APm）、肝脏纤维化指数（FIB4）对术后发生急性肝功能恶化（ALFD）的预测作用。方法按随机抽样原则从中山大学肿瘤防治中心2010年1月—2014年8月行TACE治疗的原发性HCC病例中抽取336例，对其临床资料进行回顾性分析，按照文中标准分为ALFD组与对照组，比较两组术前APRI、FIB-4与Child—Pugh评分，对这三种预测模型做ROC曲线，通过曲线下面积（AUC）、阳性预测值（PPV）、阴性预测值（NPV）比较它们对TACE术后ALFD的预测能力。结果术前Child—PuIgh评分、APRI与FIB4的AUC分别为0．783、0．752和0．758，差异无统计学意义。APRI≤1．15及FIB-4≤3．08对TACE术后ALFD的NPV和敏感度高于Child-Pugh评分〉6，分别为90．6％、93．6％、85．8％和65．6％、80．0％、27．4％，三者PPV和特异度分别为35．7％、32．9％、89．5％和73．7％、64．2％、99．3％。结论在预测TACE术后ALFD上，非侵入性肝纤维化诊断模型APRI、FIB4较Child—Pugh评分有更好的阴性预测能力、敏感度和相似的准确度，适合用于术前筛选低危患者；术前符合APRI≤1．15或nB4≤3．08，或Child—PughA级标准者可以安全接受TACE治疗。Objective To investigate the ability of two non-invasive fibrosis indexes-APRI, i.e. aspartate transaminase （AST） to platelet （PLT） ratio index, and fibrosis index based on the 4 factors （FIB- 4） score in predicting ALFD in patients with unresectable primary HCC and underwent TACE. Methods Clinical data of those patients treated with TACE in Department of Interventional Radiology of the Center from Jan 2010 to Aug 2014 were investigated retrospectively. A total of 366 cases were enrolled after randomized selection, 62 （18.5%） of which developed ALFD after TACE. Chiid-Pugh score, APRI and FIB-4 score in every case were calculated, receiver operating characteristic （ROC） curve of each model were performed and the predictive abilities of them were assessed by area under the curve （ AUC ）, positive predictive value （PPV）, negative predictive value （NPV）, sensitivity and specificity. Results The AUC of Child-Pugh score, APRI and FIB-4 score were 0. 783,0. 752 and 0. 758 respectively, while the difference had no significance in statistics, indicating that predictive accuracies of them were similar. APRI ≤ 1.15 and FIB-4≤3.08 had better NPV （ 90. 6% and 93.6% ） and sensitivity （ 65.6% and 80.0% ） than Child-Pugh score 〉 6 （ NPV = 85.8%, sensitivity = 27.4% ）, PPV and specificity of them are 35.7%, 32.9%, 89. 5% and 73.7%, 64. 2%, 99.3% respectively. Conclusion Comparing to Child-Pugh score, APRI and FIB-4 score have similar accuracy but better NPV and sensitivity in predicting post-TACE ALFD. Thereafter they are good for selection of low-risk patients for TACE treatment. Candidates with an APRI≤ 1.15 or a FIB-4 ≤ 3.08 or in Child-Pugh a stage are unlikely to develop ALFD thus could receive TACE safely.

关 键 词：癌  肝细胞 栓塞  治疗性 肝功能衰竭 

分 类 号：R735.7[医药卫生—肿瘤]