白蛋白-胆红素分级对经肝动脉化疗栓塞术治疗肝癌患者肝功能变化及其预后评估价值的Meta分析  

Value of albumin-bilirubin grade in predicting liver function changes and prognosis of hepatocellular carcinoma patients undergoing transarterial chemoembolization:A Meta-analysis

作　　者：余伟明 洪文倩 孙丙伦 韩景钊 脱红芳[2] YU Weiming;HONG Wenqian;SUN Binglun;HAN Jingzhao;TUO Hongfang(Graduate School,North China University of Science and Technology,Tangshan,Hebei 063210,China;Department of Hepatobiliary Surgery,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]华北理工大学研究生学院,河北唐山063210 [2]河北省人民医院肝胆外科,石家庄050051

出　　处：《临床肝胆病杂志》2021年第11期2575-2583,共9页Journal of Clinical Hepatology

摘　　要：目的分析白蛋白-胆红素(ALBI)分级对肝细胞癌(HCC)患者经肝动脉化疗栓塞术(TACE)后肝功能变化及其预后的评估价值。方法计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、OVID、知网、万方、维普及中国生物医学文献数据库,收集所有关于ALBI分级对TACE治疗HCC患者肝功能变化及其预后评估的相关性研究,检索时间为数据库建立至2020年12月。对纳入文献进行质量评价及数据提取后,采用RevMan 5.3软件进行Meta分析。各研究间的异质性采用χ2检验判断;用HR或OR及其对应的95%CI评价结局指标;通过漏斗图评价发表偏倚。结果共纳入18篇文献,9940例患者。Meta分析结果显示:较高ALBI等级的HCC患者TACE后总生存期(OS)短于较低ALBI等级患者(2^(nd) vs 1^(st):HR=1.48,95%CI:1.39~1.57,P<0.00001;3^(rd) vs 1^(st):HR=2.45,95%CI:1.92~3.13,P<0.00001;3^(rd) vs 2^(nd):HR=1.91,95%CI:1.71~2.13,P<0.00001)。2次TACE累积导致的ALBI恶化程度高于1次TACE(OR=1.91,95%CI:1.27~2.88,P<0.05),3次TACE累积导致的ALBI恶化程度高于1次TACE(OR=3.21,95%CI:1.95~5.28,P<0.05),3次TACE累积导致的ALBI恶化程度高于2次TACE(OR=1.70,95%CI:1.07~2.70,P<0.05)。此外,ALBI可以预测TACE后慢加急性肝衰竭(ACLF)的发生(OR=4.57,95%CI:2.76~7.57,P<0.00001)。结论重复TACE治疗可导致肝功能持续恶化,并且ALBI分级对于评估TACE的预后及预测ACLF发生风险具有重要临床价值。Objective To investigate the value of albumin-bilirubin(ALBI)grade in evaluating liver function changes and prognosis of hepatocellular carcinoma(HCC)patients undergoing transarterial chemoembolization(TACE).Methods PubMed,the Cochrane Library,EMbase,Web of Science,OVID,CNKI,Wanfang Data,VIP,and CBM databases were searched for studies on ALBI grade for evaluating liver function changes and prognosis of HCC patients undergoing TACE published up to December 2020.After quality assessment and data extraction,RevMan 5.3 was used to perform a meta-analysis of the studies included.The chi-square test was used to evaluate heterogeneity between studies;hazard ratio(HR)/odds ratio(OR)and corresponding 95%confidence interval(CI)were used to evaluate outcome measures;funnel plots were used to assess publication bias.Results A total of 18 articles were included,with 9940 patients in total.The meta-analysis showed that the HCC patients with higher ALBI grades after TACE had a shorter overall survival time than those with lower ALBI grades(2 nd vs 1 st:HR=1.48,95%CI:1.39-1.57,P<0.00001;3 rd vs 1 st:HR=2.45,95%CI:1.92-3.13,P<0.00001;3 rd vs 2 nd:HR=1.91,95%CI:1.71-2.13,P<0.00001).The degree of deterioration of ALBI caused by 2 times of TACE was higher than that caused by 1 time of TACE(OR=1.91,95%CI:1.27-2.88,P<0.05);the degree of deterioration of ALBI caused by 3 times of TACE was higher than that caused by 1 time of TACE(OR=3.21,95%CI:1.95-5.28,P<0.05);the degree of deterioration of ALBI caused by 3 times of TACE was higher than that caused by 2 times of TACE(OR=1.70,95%CI:1.07-2.70,P<0.05).In addition,ALBI grade could predict the onset of acute-on-chronic liver failure(ACLF)after TACE(OR=4.57,95%CI:2.76-7.57,P<0.00001).Conclusion Repeated TACE treatment can cause continuous deterioration of liver function based on ALBI,and ALBI has an important clinical value in predicting prognosis and the risk of ACLF after TACE.

关 键 词：ALBI分级 癌 肝细胞 化学栓塞 治疗性 预后 Meta分析(主题) 

分 类 号：R735.7[医药卫生—肿瘤]