术前外周血肝纤维化血清学指标对肝内胆管癌预后预测价值研究  

The prognostic value of preoperative peripheral blood serological indicators of liver fibrosis for intrahepatic cholangiocarcinoma after radical resection

作　　者：李起 张瑞[1] 张景玮 蔡志强[2] 司书宾[2] 张东[1] 耿智敏[1] LI Qi;ZHANG Rui;ZHANG Jing-wei(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;不详)

机构地区：[1]西安交通大学第一附属医院肝胆外科,陕西西安710061 [2]西北工业大学机电学院工业工程系,陕西西安710072

出　　处：《中国实用外科杂志》2021年第7期778-785,共8页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金(No.62076194);陕西省重点研发计划(No.2017ZDXM-SF-055)。

摘　　要：目的探讨术前外周血反映肝纤维化血清学指标对肝内胆管癌根治性切除术后病人预后预测价值。方法回顾性分析2010年1月至2018年12月于西安交通大学第一附属医院肝胆外科因肝内胆管癌行根治性切除术的124例病人的临床病理资料。采用ROC曲线确定天冬氨酸氨基转移酶血小板比值指数(APRI)、γ-谷氨酰转肽酶血小板比值指数(GPRI)、基于4因子的肝纤维化指数(FIB-4)、S指数(S-index)的最佳截断值。生存单因素分析采用Kaplan-Meier法和Log-rank检验,多因素分析采用Cox比例风险回归模型。基于Cox回归模型筛选的独立危险因素建立贝叶斯网络生存预测模型。结果单因素分析显示,APRI、GPRI、FIB-4、S-index是影响肝内胆管癌根治性切除术后病人预后的危险因素(P<0.05);多因素分析显示,S-index为独立危险因素(P<0.05)。术前S-index>0.18与≤0.18病人相比,APRI>0.50、GPRI>0.25、FIB-4>3.40、CA19-9水平>39.0 kU/L、TBIL>34.1μmol/L、合并肝内胆管结石、肝功能Child-Pugh分级B级、合并肝硬化及肿瘤大小>5 cm比例明显高于后者(P<0.05)。基于影响预后的独立危险因素建立贝叶斯网络生存预测模型,建模组及验证组AUC分别为76.3%、73.8%,模型精确度分别为71.6%、70.0%。结论术前外周血S-index对肝内胆管癌根治性切除术后病人预后具有良好的预测能力。Objective To explore the value of preoperative peripheral blood serological indicators reflecting liver fibrosis for predicting the prognosis of intrahepatic cholangiocarcinoma(ICC)after radical resection.Methods A total of 124 patients who underwent radical resection for ICC in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University from January 2010 to December 2018 were retrospectively analyzed.ROC curve was conducted to determine the best cut-off values of aspartate aminotransferase-to-platelet ratio index(APRI),γ-glutamyl transpeptidase platelet ratio index(GPRI),fibrosis-4(FIB-4),and S-index.The Kaplan-Meier method and Log-rank test were conducted for univariate analysis,and the Cox proportional hazard regression model was conducted for multivariate analysis.A Bayesian network survival prediction model was established based on independent risk factors screened by Cox regression model.Results Univariate analysis showed that APRI,GPRI,FIB-4,S-index were the prognostic factors of ICC after radical resection(P<0.05).Multivariate analysis showed that S-index was independent risk factors of ICC after radical resection(P<0.05).Preoperative blood S-index>0.18 patients compared with S-index≤0.18 patients,the proportion of APRI>0.50,GPRI>0.25,FIB-4>3.40,CA19-9>39.0 kU/L,TBIL>34.1μmol/L,combined with hepatolithiasis,Child-Pugh liver function classification(grade B),combined with liver cirrhosis,and tumor diameter>5 cm was significantly higher than the latter(P<0.05).The Bayesian network model was established based on the independent risk factors,the AUC of the model was 76.3%and 73.8%in the training set and testing set,and the accuracy was 71.6%and 70.0%,respectively.Conclusion Preoperative peripheral blood Sindex has a good predictive ability for intrahepatic cholangiocarcinoma after radical resection.

关 键 词：S指数 肝内胆管癌 肝纤维化 预后 贝叶斯网络 

分 类 号：R6[医药卫生—外科学]