血小板-白蛋白-胆红素评分联合NLR预测肝切除术后肝衰竭的价值  

Potential of the platelet-albumin-bilirubin score combined with neutrophil lymphocyte ratio in predicting the post-hepatectomy liver failure

作　　者：潘聪莹 李斯博 张雅琼 Pan Congying;Li Sibo;Zhang Yaqiong(Department of Tumor Luminal Surgery,the First Affiliated Hospital of Harbin Medical University,Heilongjiang Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院肿瘤腔镜外科,黑龙江哈尔滨150001

出　　处：《腹部外科》2025年第1期20-25,共6页Journal of Abdominal Surgery

基　　金：黑龙江省自然科学基金(H2020L31)。

摘　　要：目的 评估血小板-白蛋白-胆红素(platelet-albumin-bilirubin,PALBI)评分联合中性粒细胞与淋巴细胞比值(neutrophil lymphocyte ratio,NLR)预测肝细胞癌(简称肝癌)病人发生肝切除术后肝衰竭(post-hepatectomy liver failure,PHLF)的临床价值。方法 回顾性纳入2019年1月至2023年12月哈尔滨医科大学附属第一医院行根治性切除术治疗的328例肝癌病人,根据是否发生PHLF,分为PHLF组[62例(18.90%)]和非PHLF组[266例(81.10%)]。采用单因素和多因素logistic回归法分析PHLF的危险因素,并采用受试者操作特征(receiver operator characteristic,ROC)曲线评估PALBI评分联合NLR预测PHLF的效能。结果 PHLF组与非PHLF组比较显示,PHLF组肝硬化比例、凝血酶原时间、NLR、PALBI评分及病灶数目为多发的比例均升高,白蛋白、剩余肝脏体积均降低,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,PHLF的独立危险因素为:肝硬化(OR=1.436,95%CI:1.118~1.845),NLR(OR=1.346,95%CI:1.047~1.730),PALBI评分(OR=1.516,95%CI:1.164~1.974);而剩余肝脏体积(OR=0.725,95%CI:0.535~0.984)是保护性因素。ROC曲线显示,PALBI评分和NLR预测PHLF的曲线下面积为0.864(95%CI:0.815~0.913),敏感度为80.65%,特异度为81.58%,预测效能优于单一PALBI评分和NLR。结论 PALBI评分和NLR升高是肝癌病人根治性切除术后发生PHLF的危险因素,二者联合应用对PHLF具有良好的预测价值。Objective To assess the clinical value of platelet-albumin-bilirubin(PALBI)score combined with neutrophil lymphocyte ratio(NLR)in predicting the occurrence of post-hepatectomy liver failure(PHLF)in hepatocellular carcinoma patients.Methods A total of 328 hepatocellular carcinoma patients who underwent radical resection treatment in the First Hospital of Harbin Medical University from January 2019 to December 2023 were retrospectively included.They were divided into the PHLF group(62 cases,18.90%)and non-PHLF group(266 cases,81.10%).Risk factors for PHLF were analyzed using univariate and multivariate logistic regression,and the efficacy of PALBI score combined with NLR in predicting PHLF was assessed using receiver operator characteristic(ROC)curve.Results The proportion of cirrhosis,prothrombin time,NLR,PALBI score and number of lesions as multiple were significantly higher in the PHLF group than the non-PHLF group,while the albumin and remaining liver volume were significantly lower(all P<0.05).The results of multivariate logistic regression showed that cirrhosis(OR=1.43695%CI:1.118–1.845),NLR(OR=1.346,95%CI:1.047–1.730),and PALBI score(OR=1.516,95%CI:1.164–1.974)were the independent risk factors for PHLF,while residual liver volume(OR=0.725,95%CI:0.535-0.984)was a protective factor.The ROC curve showed that PALBI score and NLR predicted PHLF with an area under the curve(AUC)of 0.864(95%CI:0.815-0.913),a sensitivity of 80.65%,and a specificity of 81.58%,which was superior to the predictive efficacy of a single detection.Conclusion Elevated PALBI score and NLR are risk factors for PHLF after radical resection in hepatocellular carcinoma patients,and the combination of the two has good predictive value for PHLF.

关 键 词：肝切除术后肝衰竭 血小板-白蛋白-胆红素评分 中性粒细胞与淋巴细胞比值 预测 

分 类 号：R446.1[医药卫生—诊断学]