五种评分系统判断TACE术治疗原发性肝癌患者发生肝功能不全效能比较研究  

Value of five scoring systems in predicting liver dysfunction after transcatheter arterial chemoembolization in patients with primary liver cancer

作　　者：张雪[1] 胥莹[1] 安文慧 张帮婷 杨雪芳 Zhang Xue;Xu Ying;An Wenhui(Department of Gastroenterolgy,Second Affiliated Hospital,Kunming Medical University,Kunming 65000,Yunnan Province,China)

机构地区：[1]昆明医科大学第二附属医院消化内科,昆明市650000

出　　处：《实用肝脏病杂志》2021年第1期111-114,共4页Journal of Practical Hepatology

基　　金：云南省科技人才和平台计划项目(编号:2019IC034)。

摘　　要：目的比较CTP评分、终末期肝病模型(MELD)、MELD联合吲哚菁绿(ICG)清除试验(MELD-ICG)评分、慢性肝功能不全(CLD)评分和改良的白蛋白胆红素(mALBI)评分预测经肝动脉化疗栓塞(TACE)治疗的原发性肝癌(PLC)患者术后发生早期肝功能不全的效能。方法2018年12月~2019年12月我院收治的87例PLC患者,均接受TACE治疗,分别计算术前CTP、MELD、MELD-ICG、CLD和ALBI五种模型评分,随访术后发生肝功能失代偿情况。绘制受试者工作曲线(ROC)并计算曲线下面积(AUC)对五种评分的预测效能作出比较。结果在87例患者中,术后发生肝功能不全27例(31.0%);术前,肝功能不全组CTP、MELD、MELD-ICG、CLD和mALBI评分分别为(6.9±1.1)、12.0(10.0~14.0)、27.4(20.2~35.0)、(1.5±0.9)和(2.6±1.5),显著高于60例肝功能代偿组[分别为(5.8±1.5)、8.0(6.0~10.0)、12.6(7.5~17.3)、(0.8±0.6)和(1.1±0.9),P<0.05];CTP、MELD、MELD-ICG、CLD和mALBI评分预测的AUC分别为:0.708、0.787、0.827、0.735和0.723,其中MELD-ICG预测术后发生肝功能不全的AUC为0.827(95%CI:0.730~0.899),显著高于CTP[0.708(95%CI:0.630~0.824),P<0.05]或CLD[0.735(95%CI:0.630~0.824),P<0.05]或mALBI[0.723(95%CI:0.616~0.813),P<0.05]。结论CTP、MELD、MELD-ICG、CLD和mALBI五种评分系统均是预测PLC患者TACE术后发生肝功能不全的有效工具,但以MELD-ICG评分的预测价值最佳。Objective The aim of this study was to compare CTP score,end-stage liver disease model(MELD),MELD combined with indocyanine green(ICG)clearance test(MELD-ICG)score,chronic liver dysfunction(CLD)score and modified albumin bilirubin(mALBI)scores for predicting early liver dysfunction in patients with primary liver cancer(PLC)undergoing transhepatic arterial chemoembolization(TACE).Methods A retrospective analysis was performed in 87 PLC patients underwent TACE treatment in our hospital from December 2018 through December 2019,and the preoperative CTP,MELD,MELD-ICG,CLD and ALBI scores were calculated.The area under receiver operating curve(AUC)was applied to predict the incidence of liver dysfunction.Results 27(31.0%)out of 87 patients with PLC after TACE developed postoperative hepatic insufficiency in our series;the preoperative CTP,MELD,MELD-ICG,CLD and ALBI scores in the 27 patients with hepatic insufficiency were(6.9±1.1),12.0(10.0-14.0),27.4(20.2-35.0),(1.5±0.9)and(2.6±1.5),significantly higher than[(5.8±1.5),8.0(6.0-10.0),12.6(7.5-17.3),(0.8±0.6)and(1.1±0.9),respectively,P<0.05]in 60 patients with compensated liver functions;the AUC of CTP,MELD,MELD-ICG,CLD and mALBI were 0.708,0.787,0.827,0.735 and 0.723,with the AUC of MELD-ICG in predicting postoperative hepatic insufficiency highest[0.827(95%CI:0.730-0.899)],significantly higher than CTP[0.708(95%CI:0.630-0.824),P<0.05]or CLD[0.735(95%CI:0.630-0.824),P<0.05]or mALBI[0.723(95%CI:0.616-0.813),P<0.05].Conclusion The five scoring systems of CTP,MELD,MELD-ICG,CLD and mALBI are all efficacious tools for predicting hepatic dysfunction after TACE in patients with PLC,and the MELD-ICG score has the best predictive value and needs further investigation.

关 键 词：原发性肝癌 肝动脉化疗栓塞 肝功能不全 肝功能预测模型 

分 类 号：R735.7[医药卫生—肿瘤]