肝纤维化评价指标预测肝癌患者肝切除术后肝功能衰竭  

Prediction of Posthepatectomy Liver Failure in Patients with Hepatocellular Carcinoma by Evaluation Index of Liver Fibrosis

作　　者：林水荣 林浩钟 钱柏锋 李牧其 彭洪 华赟鹏[1] 彭宝岗[1] 沈顺利[1] LIN Shui-rong;Lin Hao-zhong;QIAN Bai-feng;LI Mu-qi;PENG Hong;HUA Yun-peng;PENG Bao-gang;SHEN Shun-li(Department of Hepatic Surgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China;Department of Biliary and Pancreatic Surgery,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院肝外科,广东广州510080 [2]中山大学附属第一医院胆胰外科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2021年第6期874-882,共9页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自科学基金(81900546)。

摘　　要：【目的】天冬氨酸转氨酶-血小板比率指数(APRI)与肝脏纤维化-4指数(FIB-4)等指标已被证实可用于无创性评估肝纤维化、肝硬化程度,对肝细胞癌(HCC)患者肝切除术预后评估有较高的准确性。本研究旨在探讨APRI与FIB-4对HCC患者肝切除术后发生肝功能衰竭(PHLF)的预测能力。【方法】回顾性分析426例在我院接受肝切除术的HCC患者的临床资料。收集患者肝切除术前2周内的实验室数据,计算APRI、FIB-4、Child-Pugh评分。采用受试者工作特征(ROC)曲线确定APRI、FIB-4、Child-Pugh评分的AUC值和最佳临界值。采用单因素和多因素Logistics回归分析确定PHLF的独立危险因素,对比APRI和FIB-4对PHLF的预测能力。【结果】本研究中共有11.3%(48/426)患者发生PHLF。多因素分析显示:大范围肝切除术(≥3个肝段切除)、失血量>400 mL,TBIL、PLT、纤维蛋白原以及APRI、FIB-4均为PHLF的独立危险因素;ROC曲线分析显示:APRI(AUC=0.816)和FIB-4(AUC=0.728)对PHLF的预测能力均优于Child-Pugh评分(AUC=0.566)P均<0.001。【结论】术前APRI与FIB-4都是HCC患者肝切除术后发生PHLF的独立预测因子并有良好的预测价值。【Objective】The aspartate aminotransferase-to-platelet ratio index(APRI)and liver fibrosis-4 index(FIB-4)have been used for noninvasive prediction of liver fibrosis and cirrhosis and both indexes exhibit a high degree of accuracy in the the prediction of the prognosis of hepatocellular carcinoma(HCC)patients after hepatectomy..This study aims to explore the predictive values of APRI and FIB-4 in the occurrence of posthepatectomy liver failure(PHLF)in HCC patients.【Methods】The clinical data of 426 patients with HCC who underwent hepatectomy in our hospital were retrospectively analyzed.Laboratory data were collected from patients within 2 weeks prior to hepatectomy.APRI,FIB-4 and Child-Pugh scores were calculated.Receiver operating characteristic(ROC)curves were used to determine the AUC values and optimal cut-off values of APRI,FIB-4 and Child-Pugh scores.Univariate and multivariate logistic regression analyses were employed to identify the independent risk factors for PHLF,and the predictive values of APRI and FIB-4 on PHLF were compared.【Results】A total of 48 patients(11.3%)developed PHLF.Multivariate analysis showed that major hepatectomy(≥3 segments resection),blood loss>400 mL,total bilirubin(TBIL),platelet(PLT),fibrinogen(Fib),APRI and FIB-4 were independent risk factors for PHLF.ROC curve analysis revealed that APRI(AUC=0.816)and FIB-4(AUC=0.728)had better ability to predict PHLF than Child-Pugh score(AUC=0.566;P<0.001).【Conclusions】Preoperative APRI and FIB-4 are independent predictors of PHLF in HCC patients after hepatectomy and have good predictive values.

关 键 词：肝细胞癌 天冬氨酸转氨酶-血小板比率指数 肝脏纤维化-4指数 肝切除术后肝功能衰竭 CHILD-PUGH评分 

分 类 号：R657.3[医药卫生—外科学]