白蛋白-胆红素评分联合血氨检测对原发性肝癌切除术后并发肝性脑病的预测价值  

Predictive value of albumin-bilirubin score in combination with blood ammonia detection for hepatic encephalopathy after resection of primary liver cancer

作　　者：柴晓哲[1] 朱霞峰 王少峰[4] 骆成林[3] CHAI Xiao-zhe;ZHU Xia-feng;WANG Shao-feng;LUP Cheng-lin(Department of Gastroenterology,the Fifth People’s Hospital of Suzhou,Jiangsu 215100,China;Department of Clinical Laboratory,Suzhou Xiangcheng People’s Hospital,Jiangsu 215131,China;Department of Gastroenterology,the Second Affiliated Hospital of Suzhou University,Jiangsu 215100,China;Department of Gastroenterology,Suzhou Xiangcheng People’s Hospital,Jiangsu 215131,China)

机构地区：[1]苏州市第五人民医院消化内科,江苏215100 [2]苏州市相城人民医院检验科 [3]苏州市相城人民医院消化内科 [4]苏州大学附属第二医院消化内科

出　　处：《肝脏》2022年第9期994-998,共5页Chinese Hepatology

基　　金：苏州市科技局科研计划项目(SKJYD2021036)。

摘　　要：目的探讨白蛋白-胆红素(ALBI)评分联合血氨检测对原发性肝癌切除术后并发肝性脑病(HE)的预测价值。方法选择2016年5月至2021年3月苏州市第五人民医院89例拟行原发性肝癌切除术患者。根据患者术后是否并发肝性脑病(HE)将患者分为HE组和非HE组,比较两组患者的临床资料,logistic回归分析原发性肝癌切除术后并发HE的影响因素,以ROC曲线下面积(AUC)判定预测价值。结果89例原发性肝癌切除术后随访3个月,并发HE 21例,未并发HE 68例。HE组Child分级为C级12例(57.14%)、血氨浓度(56.47±9.58)μmol/L、凝血酶原时间(PT)(23.86±4.35)s、直接胆红素(DBil)(93.27±10.63)μmol/L,高于非HE组的19例(27.94%)、(35.34±6.27)μmol/L、(15.24±3.28)s、(12.95±2.67)μmol/L(P<0.05);HE组的ALBI评分(-1.78±0.46)分、白蛋白(Alb)(29.43±6.19)分低于非HE组的(-1.12±0.54)分、(33.66±7.84)分(P<0.05)。logistic回归分析结果显示,Child分级为C级、血氨浓度、ALBI评分为原发性肝癌切除术后并发HE的危险因素(95%CI分别为1.246~7.360、1.125~6.646、1.267~7.486,OR分别为3.028、2.735、3.080,均P<0.05)。术前血氨浓度、ALBI评分及二者联合对原发性肝癌切除术后并发HE预测的AUC值分别为0.784、0.775、0.893,(P<0.05)。结论术前检测ALBI评分及血氨浓度对预测原发性肝癌切除术后并发HE具有一定的价值,且联合检测的预测价值更高。Objective To explore the predictive value of albumin-bilirubin(ALBI)score in combination with blood ammonia detection for hepatic encephalopathy(HE)after the resection of primary liver cancer(PLC).Methods Eighty-nine patients who had undergone PLC resection between May 2016 and March 2021 were enrolled in this study.All patients were follow-up for 3 months after the resection.They were divided into HE group and non-HE group according to whether they were complicated with HE after operation.ALBI score and blood ammonia concentration were tested in all patients before operation.The clinical data of the two groups of patients were compared.Logistic regression analysis was used to analyze the influencing factors of HE after PLC resection.Receiver operating curve(ROC)was drawn and the area under the ROC curve(AUC)was used to determine the value of ALBI score combined with blood ammonia for predicting HE.Results Within the 89 patients,21 cases were complicated with HE(HE group)with an incidence rate of 23.60%;68 cases were without HE after operation(non-HE group).The proportion of cases with Child-Pugh grade C(57.14%),the levels blood ammonia concentration(56.47±9.58)μmol/L,prothrombin time(PT)(23.86±4.35)s,direct bilirubin(DBIL)(93.27±10.63)μmol/L In the HE group were higher than those of 27.94%,(35.34±6.27)μmol/L,(15.24±3.28)s,and(12.95±2.67)μmol/L in the non-HE group(P<0.05).The ALBI score(-1.78±0.46)and albumin(ALB)(29.43±6.19)in the HE group were lower than those of(-1.12±0.54)and(33.66±7.84)in the non-HE group(P<0.05).Logistic regression analysis showed that Child-Pugh grade C,blood ammonia concentration,and ALBI score were all risk factors for HE after PLC resection(95%CI=1.246~7.360,1.125~6.646,1.267~7.486,and OR=3.028,2.735,3.080,respectively,all P<0.05).The AUC values(95%CI)of preoperative blood ammonia concentration,ALBI score and the combination of them for predicting postoperative HE after PLC resection were 0.784(0.693~0.875),0.775(0.683~0.867),and 0.893(0.782~0.941),respectively(P<0.05).Con

关 键 词：白蛋白-胆红素评分 血氨 原发性肝癌 肝性脑病 

分 类 号：R735.7[医药卫生—肿瘤]