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  • 麦荣云,曾洁,叶甲舟,苏奇斌,龙中荣,施显茂,黄山,吴飞翔,黎乐群,连芳,邬国斌.术前天冬氨酸转氨酶与血小板比值指数预测原发性肝癌肝切除术后肝衰竭的价值[J].第二军医大学学报,2019,40(1):61-67    [点击复制]
  • MAI Rong-yun,ZENG Jie,YE Jia-zhou,SU Qi-bin,LONG Zhong-rong,SHI Xian-mao,HUANG Shan,WU Fei-xiang,LI Le-qun,LIAN Fang,WU Guo-bin.Clinical value of preoperative aspartate aminotransferase-to-platelet ratio index in predicting liver failure after hepatectomy for primary liver cancer[J].Acad J Sec Mil Med Univ,2019,40(1):61-67   [点击复制]
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术前天冬氨酸转氨酶与血小板比值指数预测原发性肝癌肝切除术后肝衰竭的价值
麦荣云1△,曾洁1△,叶甲舟1,苏奇斌1,龙中荣1,施显茂1,黄山1,吴飞翔1,黎乐群1,连芳2,邬国斌1*
0
(1. 广西医科大学附属肿瘤医院肝胆外科, 南宁 530021;
2. 广西医科大学基础医学院生理学教研室, 南宁 530021
共同第一作者
*通信作者)
摘要:
目的 探讨术前天冬氨酸转氨酶与血小板比值指数(APRI)预测原发性肝癌患者发生肝切除术后肝衰竭(PHLF)的价值。方法 回顾性分析2013年9月至2016年12月在广西医科大学附属肿瘤医院接受首次肝切除术治疗的原发性肝癌患者资料,采用logistic回归分析和受试者工作特征(ROC)曲线评估Child-Pugh评分、终末期肝病预后模型(MELD)评分、白蛋白-胆红素(ALBI)评分及APRI预测PHLF的能力。结果 纳入本研究的1 108例原发性肝癌肝切除术患者中,共有217例(19.58%)发生PHLF。Logistc回归分析显示,Child-Pugh评分、MELD评分、ALBI评分及APRI是PHLF的预测因素(P均<0.05);ROC曲线分析显示,术前APRI[曲线下面积(AUC)为0.745,95%置信区间(CI):0.709~0.781,P<0.001]预测PHLF发生的能力明显优于Child-Pugh评分(AUC为0.561,95%CI:0.516~0.605,P=0.005)、MELD评分(AUC为0.650,95%CI:0.610~0.691,P<0.001)和ALBI评分(AUC为0.662,95%CI:0.621~0.703,P<0.001)。根据约登指数得到术前APRI的最佳截断值为0.55,此时APRI预测PHLF的灵敏度和特异度分别为71.9%和68.5%,APRI>0.55的患者PHLF的总体发病率及PHLF A、B、C各等级的发病率均高于APRI ≤ 0.55的患者(P均<0.05)。结论 术前APRI预测原发性肝癌患者发生PHLF的能力优于Child-Pugh评分、MELD评分及ALBI评分,对于原发性肝癌的临床治疗决策具有一定的指导意义。
关键词:  肝肿瘤  肝切除术后肝衰竭  天冬氨酸转氨酶与血小板比值指数  Child-Pugh评分  终末期肝病预后模型评分  白蛋白-胆红素评分
DOI:10.16781/j.0258-879x.2019.01.0061
投稿时间:2018-08-11修订日期:2018-11-12
基金项目:国家自然科学基金(81460426,81803007),广西壮族自治区卫生与计划生育委员会适宜推广技术项目(s201629).
Clinical value of preoperative aspartate aminotransferase-to-platelet ratio index in predicting liver failure after hepatectomy for primary liver cancer
MAI Rong-yun1△,ZENG Jie1△,YE Jia-zhou1,SU Qi-bin1,LONG Zhong-rong1,SHI Xian-mao1,HUANG Shan1,WU Fei-xiang1,LI Le-qun1,LIAN Fang2,WU Guo-bin1*
(1. Department of Hepatobiliary Surgery, Tumor Hospital Affiliated to Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China;
2. Department of Physiology, School of Preclinical Medicine, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To explore the predictive value of preoperative aspartate aminotransferase-to-platelet ratio index (APRI) for post-hepatectomy liver failure (PHLF) after hepatectomy in the patients with primary liver cancer (PLC).Methods A retrospective study was conducted on the data from the PLC patients who underwent first hepatectomy in Tumor Hospital Affiliated to Guangxi Medical University between Sep. 2013 and Dec. 2016. The logistic regression model and receiver operating characteristic (ROC) curve were performed to determine the predicting values of APRI, Child-Pugh score, model for end-stage liver disease (MELD) score and albumin-bilirubin (ALBI) score for PHLF.Results A total of 1 108 PLC patients were included in this study, and PHLF occurred in 217 (19.58%) patients. The logistic regression analysis showed that Child-Pugh score, MELD score, ALBI score and APRI were predicting factors for PHLF (all P<0.05). The ROC curve analysis showed that preoperative APRI (area under curve[AUC]:0.745, 95% confidence interval[CI] 0.709-0.781, P<0.001) was significantly better for predicting PHLF compared with Child-Pugh score (AUC 0.561, 95% CI 0.516-0.605, P=0.005), MELD score (AUC 0.650, 95% CI 0.610-0.691, P<0.001) and ALBI score (AUC 0.662, 95% CI 0.621-0.703, P<0.001). Based on Youden index, the best cut-off value of preoperative APRI was 0.55 for predicting PHLF in PLC patients, with a sensitivity of 71.9% and a specificity of 68.5%, and the patients with APRI>0.55 had significantly higher overall incidence of PHLF, and higher incidence of PHLF A, B and C compared with ones with APRI ≤ 0.55 (all P<0.05).Conclusion Preoperative APRI is more accurate for predicting PHLF after hepatectomy in PLC patients versus the Child-Pugh, MELD and ALBI scores, providing guiding significance for clinical treatment of PLC.
Key words:  liver neoplasms  post-hepatectomy liver failure  aspartate aminotransferase to platelet ratio index  ChildPugh score  model for end-stage liver disease score  albumin-bilirubin score