TSP-1和TGF-β在预测肝部分切除术后肝衰竭的临床价值  

Clinical value of thrombospondin-1 and transforming growth actor-βin predicting post hepatectomy liver failure

作　　者：哈肖别克·哈斯木[1] 吴警 姚刚 沙地克·阿帕尔 夏普开提·甫拉提 张云飞 阿卜杜萨拉木·图尔荪麦麦提 吐尔洪江·吐逊[1,2] Haxiaobieke Hasimu;WU Jing;YAO Gang;Shadike Apaer;Xiapukaiti Fulati;ZHANG Yun-fei;Abudushalamuu Tuersunmaimaiti;Tuerhongjiang Tuxun(Department of Liver&Laparoscopic Surgery,Fisrt Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Digestive and Vascular Surgery Center,Fisrt Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院肝脏•腹腔镜外科,新疆乌鲁木齐830054 [2]新疆医科大学第一附属医院消化血管外科中心,新疆乌鲁木齐830054

出　　处：《中国现代普通外科进展》2024年第6期442-446,共5页Chinese Journal of Current Advances in General Surgery

基　　金：国家自然科学基金项目(82270632,82260411);新疆维吾尔自治区科技厅重点实验室开放课题项目(2018D04002)。

摘　　要：目的:探讨肝部分切除术后血浆凝血酶敏感蛋白1(TSP-1)与转化生长因子β (TGF-β)动态变化以及其在预测肝部分切除术后肝衰竭(PHLF)的临床价值。方法:回顾性分析2016年1月至2019年3月新疆医科大学第一附属医院收治的113例肝切除术患者临床资料。其中男59例,女54例;平均年龄(41.00±13.98)岁。依据国际肝脏外科研究小组(ISGLS)标准将患者分为PHLF发生组(40例)和PHLF未发生组(73例)。观察两组围手术期血浆TSP-1和TGF-β动态变化,并采用受试者工作特征(ROC)曲线分析TSP-1、TGF-β水平对PHLF的预测价值。根据ROC曲线临界值将TSP-1分为TSP-1high组和TSP-1low组,分析二者与PHLF相关性。两组TSP-1、TGF-β比较采用t检验或MannWhitney秩和检验,率的比较采用χ^(2)检验或Fisher确切概率法。结果:共40例患者出现不同程度的PHLF。PHLF发生组术后第1天及术后第7天TSP-1水平明显高于PHLF未发生组。术后第1天TSP-1、术后第7天TSP-1诊断PHLF的ROC曲线下面积分别为0.725和0.81,灵敏度分别为0.864和0.818,特异度分别为0.647和0.765。结论:PHFL发生与肝切除范围、Child-Pugh分级及术后第1天TSP-1有关。术后第1天TSP-1水平可作为预测PHLF有效的参考指标。Objective:To explore the dynamic changes of thrombosbondin-1(TSP-1)and transforming growth factor beta(TGF-β)in patients who underwent hepatectomy and their clinical value in predicting post-hepatectomy liver failure(PHLF).Methods:Clinical data of 113 patients who received hepatectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to March 2019 were retrospectively analyzed.The cohort comprised 59 males and 54 females,with an average age of(41.00±13.98)years.According to the standard of the International Study Group of Liver Surgery(ISGLS),TSP-1 was divided into the PHLF group(n=40)and the non-PHLF group(n=73).The dynamic changes of plasma TSP-1 and TGF-βplasma levels during perioperative period were observed.The definition and diagnostic criteria suggested by ISGLS was used to evaluate PHLF.The value of plasma TSP-1 and TGF-βlevel in predicting PHLF were analyzed by calculating areas under the receiver operating characteristic curves(AUCs).Patients were divided into TSP-1high group and TSP-1 low groups based upon the ROC cutoff values and their correlation with PHLF was analyzed.T test and Mann-Whitney rank sum test were performed to compare the TSP-1 and TGF-βlevels between the two groups.The rate comparison was carried out by Chi-square test or Fisher's exact test.Results:In this study,40 patients experienced varying degrees of PHLF.The plasma levels of TSP-1 on postoperative day 1(POD1)and day 7(POD 7)in the PHLF group were significantly higher than those in the non-PHLF group(P<0.05,P<0.01,respectively).The area under the ROC curve of plasma TSP-1 level on postoperative 1 d in the diagnosis of PHLF was 0.725,with sensitivity of 0.864 and specificity of 0.647.The area under the ROC curve of plasma TSP-1 level on postoperative 7 d in the diagnosis of PHLF was 0.81,with sensitivity of 0.818 and specificity of 0.765.Conclusion:The incidence of PHLF is related to the extent of liver resection,Child-Pugh grade and TSP-1 levels on postoperative day 1.The concentration level o

关 键 词：肝部分切除术后肝衰竭 凝血酶敏感蛋白-1 转化生长因子-Β 

分 类 号：R657.3[医药卫生—外科学]