摘要
目的探讨血清前白蛋白-胆红素评分（PALBI）预测乙型肝炎病毒（HBV）相关性肝细胞癌（HCC）肝切除术后肝衰竭（PHLF）的价值。方法回顾性分析广西医科大学附属肿瘤医院2013年9月至2016年12月接受肝切除治疗的919例HBV相关性HCC患者资料。按照3∶1随机匹配将患者分为建模组（689例）和验证组（230例），建模组依据是否发生PHLF分为对照组（546例）和PHLF组（143例）。采用多因素logistic回归模型分析建模组中与PHLF相关的因素，随后建立PALBI。通过受试者工作特征曲线（ROC）下面积（AUC）评价该模型预测PHLF的能力，并与Child-Pugh、终末期肝病模型（MELD）、白蛋白-胆红素（ALBI）评分比较。结果单因素分析和多因素logistic回归分析显示，HBV-DNA≥103 IU/ml、总胆红素、前白蛋白、血小板计数、AST、凝血酶原时间、术中出血≥400 ml、大范围切除等因素与PHLF密切相关。建模组全部患者PALBI评分（AUC＝0.728）术前预测PHLF的能力优于Child-Pugh评分（AUC＝0.552）、MELD评分（AUC＝0.651）及ALBI评分（AUC＝0.640）。验证组全部患者也得到相似结果（AUC：0.752比0.599比0.641比0.678）。为了消除小残余肝体积对PHLF的影响，于小范围肝切除患者分别计算建模组与验证组各项评分预测PHLF的能力，也得到相似的结果。结论PALBI评分预测HBV相关性HCC患者PHLF能力显著优于Child-Pugh、MELD及ALBI评分，是一种简单、无创、可靠的全新预测PHLF模型。
Objective To study the value of serum prealbumin - bilirubin score （PALBI） in predicting posthepatectomy liver failure （PHLF） for patients with HBV related hepatocellular carcinoma （HCC）.Methods A retrospective study was conducted on 919 HBV-related HCC patients who underwent hepatectomy from September 2013 to December 2016 at the Affiliated Tumor Hospital of Guangxi Medical University. These patients were divided into a training cohort （n=689） and a validation cohort （n=230） using the 3∶1 matching principle. The training cohort was divided into the control group （n=546） and the PHLF group （n=143） according to whether PHLF occurred. The multivariate logistic regression model was used to analyze the factors related to PHLF in the training cohort, and then the PALBI score was established. The ability of the PALBI score to predict PHLF was evaluated by the area under the receiver operating characteristic curve （AUC ） and compared with the Child-Pugh, model for end-stage liver disease （MELD）, and albumin-bilirubin （ALBI） scores.Results Univariate and multivariate logistic regression analyses showed the factors including HBV-DNA≥103 IU/ml, total bilirubin, prealbumin, platelet count, AST, prothrombin time, intraoperative blood loss≥400 ml and major liver resection were closely related to PHLF. The ability of the PALBI score （AUC=0.733） to predict PHLF preoperatively was superior to the Child-Pugh score （AUC=0.562）, the MELD score （AUC=0.652） and the ALBI score （AUC=0.683） in the entire training cohort. Similar results were obtained in the entire validation cohort （AUC： 0.752 vs. 0.599 vs. 0.641 vs. 0.678）. To eliminate the effect of a small residual liver volume on PHLF, the ability of each of these scores in the training and validation cohorts to predict PHLF was calculated respectively in these 2 cohorts of patients who underwent only minor liver resection, and similar results were obtained.
Conclusion The PALBI score was significantly superior to the Child-Pugh, MELD and ALBI scores in predicting PHLF in patients with HBV-related HCC who underwent liver resection. The PALBI score is a simple, non-invasive and reliable novel model in predicting PHLF.
作者
麦荣云
叶甲舟
曾洁
施显茂
龙中荣
刘劲梧
陈智炜
黄山
连芳
黎乐群
吴飞翔
邬国斌
Mai Rongyun;Ye Jiazhou;Zeng Jie;Shi Xianmao;Long Zhongrong;Liu Jinwu;Chen Zhiwei;Huang Shah;Lian Fang;Li Lequn;Wu Feixiang;Wu Guobin(Department of Hepatobiliary Surgery,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2018年第11期737-741,共5页
Chinese Journal of Hepatobiliary Surgery
基金
国家自然科学基金（81460426）
广西医疗卫生适宜技术开发与推广应用项目（s201629）
广西科学技术厅重点研发课题（桂科AB16380242）
