肝癌肝切除术后持续低蛋白血症的相关因素分析

Factors related to continual hypoproteinemia after hepatectomy for patients with hepatocellular carcinoma

目的探讨影响原发性肝细胞癌（HCC）肝切除术后持续低蛋白血症的因素。方法回顾性分析2007年3月至2010年7月川北医学院附属医院收治的行肝切除术的88例HCC患者的临床资料。用Logistic回归模型对肝切除术后持续低蛋白血症发生的相关因素进行单因素和多因素分析。应用ROC曲线评估术后持续低蛋白血症发生的风险，并作风险等级划分。结果共有17例患者术后持续低蛋白血症。单因素分析结果显示，腹腔积液、Child分级、肿瘤直径、术中出血量及输血量、术前ALP及Hb、术前WBC≥10×10^9／L、术前AST等于或高于正常值2倍以及肝门阻断等与术后持续低蛋白血症的发生相关（OR=2．592，5．154，6．848，2．249，3．336，5．296，0．285，15．000，3．281，1．716，P〈0．05）。多因素分析结果显示肿瘤直径、术前Hb、肝门阻断是影响患者术后是否发生持续低蛋白血症的独立危险因素（Wald=9．326，6．151，4．253，P〈0．05）。不同风险等级的患者术后持续低蛋白血症的发生率差异有统计学意义（X2=18．607，P〈0．05）。结论术前纠正贫血、术中尽量采用半肝阻断能减少术后持续低蛋白血症发生的风险。

Objective To investigate the factors related to continual hypoproteinemia after hepatectomy for patients with hepatocellular carcinoma （ HCC ）. Methods The clinical data of 88 patients with HCC who received hepatectomy at the Affiliated Hospital of North Sichuan Medical College from March 2007 to July 2010 were retrospectively analyzed. Multivariate and univariate analysis of the factors related to continual hypoproteinemia after hepatectomy were performed using Logistic regression model. Risk factors of hypoproteinemia and risk stratifi- cation were analyzed by using the receiver operator characteristic （ROC） curve. Results Seventeen patients were complicated with continual hypoproteinemia postoperatively. The results of univariate analysis revealed that pleural effusion, Child classification, tumor diameter, volume of intraoperative blood loss and blood transfusion, preopera- tive alkaline phosphatase level, preoperative hemoglobin level, preoperative white blood cells t〉 10 x 109/L, pre- operative aspartate aminotransferase 2 times higher than the normal level, portal vein occlusion were correlated with postoperative continual hypoproteinemia （OR =2. 592, 5. 154, 6. 848, 2. 249, 3. 336, 5. 296, 0. 285, 15. 000, 3. 281, 1. 716, P 〈0.05 ）. The result of multivariate analysis revealed that the diameter of tumor, preoperative hemoglobin concentration and hepatic portal occlusion were correlated with postoperative continual hypoproteinemia （Wald = 9. 326, 6. 151, 4. 253, P 〈 0.05 ）. There was a significant difference in the incidence of postoperative continual hypoproteinemia among patients with different risk stratification （X2 = 18. 607, P 〈0.05 ）. Conclusion Improving anemia and hemihepatic vascular control instead of hepatic portal occlusion can help to reduce the risk of postoperative continual hypoproteinemia.