Fib4、APRI预测肝细胞癌患者肝切除术后肝衰竭的价值  

The value of Fib4 and APRI in predicting liver failure after hepatectomy in patients with hepatocellular carcinoma

作　　者：刘俊杰 赵晋明[1] 刘玉涛 木拉地里江·买提巴克 谷昊[1] Liu Junjie;Zhao Jinming;Liu Yutao;Muradiljan·Matbaki;Gu Hao(Department of Liver Transplantation and Laparoscopic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,Chnia)

机构地区：[1]新疆医科大学第一附属医院肝移植腹腔镜外科,乌鲁木齐830054

出　　处：《中华肝胆外科杂志》2022年第11期808-811,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：新疆维吾尔自治区自然科学基金(2017D01C306)。

摘　　要：目的:评估术前天冬氨酸氨基转移酶/血小板比值指数(APRI)和纤维化指数4(Fib4)预测肝细胞癌患者肝切除术后肝衰竭(PHLF)的价值。方法:回顾性收集新疆医科大学第一附属医院2014年1月至2020年1月收治的587例肝细胞癌患者资料并分析,其中男性412例,女性175例,年龄(56.8±11.2)岁。单因素和多因素logistic回归分析PHLF的影响因素。通过受试者工作特征(ROC)曲线评估Child-Pugh评分、终末期肝病模型(MELD)评分、APRI和Fib4预测PHLF的能力。结果:587例患者中肝切除术后发生肝衰竭186例(31.7%)。在多因素分析中,肝细胞癌患者APRI(OR=2.660,95%CI:1.314~5.384,P=0.007)、Fib4(OR=1.322,95%CI:1.157~1.511,P<0.001)的数值越高PHLF风险越大。Fib4、APRI、MELD评分、Child-Pugh评分预测肝细胞癌患者PHLF的ROC曲线下面积为0.719、0.686、0.618、0.565,四个模型曲线下面积比较,差异均有统计学意义(均P<0.05)。结论:APRI和Fib4是肝细胞癌患者PHLF的危险因素,预测PHLF优于Child-Pugh评分和MELD评分。Objective To evaluate the value of preoperative aspartate aminotransferaseto platelet ratio index(APRI)and fibrosis index 4(Fib4)in predicting posthepatectomy liver failure(PHLF)of primary hepatocellular carcinoma.Methods The data of 587 patients with hepatocellular carcinoma admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2014 to January 2020 were retrospectively collected and analyzed,including 412 males and 175 females,aged(56.8±11.2)years.Univariate and multivariate logistic regression were used to analyze the influencing factors of PHLF.The ability of Child-Pugh score,model for end-stage liver diseas(MELD)score,APRI and Fib4 to predict PHLF was evaluated through the receiver operating characteristic(ROC)curve of subjects.Results Among 587 patients,186(31.7%)had liver failure after hepatectomy.In multivariate logistic regression analysis,APRI(OR=2.660,95%CI:1.314-5.384,P=0.007)and Fib4(OR=1.322,95%CI:1.157-1.511,P<0.001)were risk factors for PHLF in patients with hepatocellular carcinoma.The higher the number,the greater the risk of PHLF.The predicted area under the ROC curve of PHLF in patients with hepatocellular carcinoma was Fib4(0.719)>APRI(0.686)>MELD score(0.618)>Child-Pugh score(0.565).Conclusion APRI and Fib4 were risk factors of PHLF in patients with hepatocellular carcinoma.They predict the occurrence of PHLF better than Child-Pugh score and MELD score.

关 键 词：肝功能衰竭 天冬氨酸氨基转移酶/血小板比值指数 纤维化指数4 终末期肝病模型评分 CHILD-PUGH评分 

分 类 号：R735.7[医药卫生—肿瘤] R575.3[医药卫生—临床医学]