TSP-1和TGF-β在肝切除术后肝衰竭预测中的价值  

Value of TSP-1 and TGF-β in predicting posthepatectomy liver failure

作　　者：江多斯.帕依孜吾拉 吐尔洪江.吐逊 李涛 赵晋明 沙地克.阿帕尔 赵培吉 温浩 Jiangduosi Payiziwula;Tuerhongjiang Tuxun;Li Tao;Zhao Jinming;Shadike Apaer;Zhao Peiji;Wen Hao(Center of Digestive andVascular Surgery,Liver Transplantation & Laparoscopic Surgery,the First Affiliated Hospital of XinjiangMedical University,State Key Laboratory of Pathogenesis,Prevention and Treatment of High IncidenceDiseases in Central Asian,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院消化血管外科中心肝移植.腹腔镜外科新疆医科大学省部共建中亚高发病成因与防治国家重点实验室,乌鲁木齐830054

出　　处：《中华肝脏外科手术学电子杂志》2019年第2期149-153,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81560329);新疆维吾尔自治区重点科研项目(201430123-2);新疆维吾尔自治区重点实验室开放课题(2018D04002)

摘　　要：目的探讨肝切除术后血浆血小板反应素-l(TSP-1)和TGF-β在预测肝切除术后肝衰竭(PHLF)的价值。方法回顾性分析2017年10月至2018年3月在新疆医科大学第一附属医院收治的50例肝切除术患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男29例,女21例;平均年龄(41±14)岁。按术中切除肝段的数量是否≥3个,将患者分为大范围肝切除术组(大范围组,37例)和小范围肝切除术组(小范围组,13例)。观察两组围手术期血浆TSP-1和TGF-β动态变化。按"50-50标准"判定PHLF,并采用受试者工作特征(ROC)曲线分析TSP-1、TGF-β水平对PHLF的预测价值。两组TSP-1、TGF-β比较采用t检验或Mann-Whitney秩和检验,率的比较采用χ2检验或Fisher确切概率法。结果本组患者PHLF发生率20%(10/50),其中大范围组发生率为27%(10/37),明显高于小范围组的0 (P<0.05)。大范围组术后1、2、5、7 d血浆TSP-1水平分别为3 417 (974,7 090)、3 425(819,4 961)、3 347(815,4 957)、3 526(1 213,8 715)μg/L,明显高于小范围组的891(388,1 695)、1 094(572,1 476)、1 097(736,1 611)、1 061(479,1 642)μg/L (Z=2.621,2.245,2.190,3.354;P<0.05)。大范围组术后2、7 d血浆TGF-β为2.57(1.52,4.08)、3.56(1.46,4.60)μg/L,明显高于小范围组的1.52(1.20,2.20)、1.50(1.13,1.65)μg/L(Z=2.444, 2.691;P<0.05)。术后1 d血浆TSP-1诊断PHLF的ROC曲线下面积为0.88,敏感度为1.00,特异度为0.75。结论大范围肝切除术患者术后血浆TSP-1和TGF-β明显升高,且肝切除范围与PHFL发生有关。术后1 d血浆TSP-1水平可作为预测PHLF有效的参考指标。Objective To explore the value of plasma thrombospondin-l (TSP-1) and transforming growth factor-β(TGF-β) in predicting posthepatectomy liver failure (PHLF). Methods Clinical data of 50 patients undergoing hepatectomy in the First Affiliated Hospital of Xinjiang Medical University from October 2017 to March 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 29 patients were male and 21 female, aged (41±14) years on average. According to whether the number of the resected segments was≥3, all patients were divided into the extensive hepatectomy (extensive group, n=37) and limited hepatectomy groups (limited group, n=13). The dynamic changes of plasma levels of TSP-1 and TGF-β during the perioperative period were observed in two groups. PHLF was evaluated by the "50-50 criteria". The value of TSP-1 and TGF-β levels in predicting PHLF was analyzed by the receiver operating characteristic (ROC) curve. The TSP-1 and TGF-β levels were compared between two groups by t test or Mann-Whitney rank sum test. The rate comparison was carried out by Chi-square test or Fisher's exact test. Results The total incidence of PHLF was 20%(10/50), 27%(10/37) in the extensive group, significantly higher than 0 in the limited group (P<0.05). In the extensive group, the plasma levels of TSP-1 at postoperative 1, 2, 5 and 7 d were 3 417(974, 7 090), 3 425(819, 4 961), 3 347(815, 4 957) and 3 526(1 213, 8 715)μg/L, significantly higher compared with 891(388, 1 695), 1 094(572, 1 476), 1 097(736, 1 611) and 1 061(479, 1 642)μg/L in the limited group (Z=2.621, 2.245, 2.190, 3.354;P<0.05). The plasma levels of TGF-β at postoperative 2 and 7 d were 2.57(1.52, 4.08) and 3.56(1.46, 4.60)μg/L in the extensive group, significantly higher than 1.52(1.20, 2.20) and 1.50(1.13, 1.65)μg/L in the limited group (Z=2.444, 2.691;P<0.05). The area under ROC curve of plasma TSP-1 level at postoperative 1 d in the diagnosis of PHLF was 0.88, with

关 键 词：肝切除术 血小板反应素-1 转化生长因子-Β 肝功能衰竭 

分 类 号：R575.3[医药卫生—消化系统]