术后早期低总胆固醇血症在预测肝切除术后严重并发症中的价值

Early postoperative hypocholesterolemia as a predictor of severe complications after hepatectomy

目的：探讨术后早期低总胆固醇血症在预测肝切除术后严重并发症中的价值。方法回顾性分析2009年至2011年间接受肝切除术的350例患者术后早期血总胆固醇水平与术后严重并发症之间的关系。结果受试者工作特征曲线提示术前总胆固醇/术后5d内总胆固醇谷值比（以下简称术前/术后总胆固醇比）对术后严重并发症有预测价值，其曲线下面积为0．84（95％可信限0．78～0．90，P＝0．029）。依据该曲线，术前/术后总胆固醇比的诊断值为1．69；其敏感性为73．4％，特异性为85．2％。多因素分析显示术前/术后总胆固醇比＞1．69为术后严重并发症的独立危险因素。结论术后早期低总胆固醇血症对肝切除术后严重并发症有较好预测价值。

Objective To investigate the value of early postoperative hypocholesterolemia in predicting severe complications after hepatectomy. Methods A total of 350 consecutive patients receiving hepatectomy from 2009 to 2011 were enrolled. The relationship between early postoperative total cholesterol （ TC ） level and severe postoperative complications was retrospectively analyzed. Results The ratio of pre- operative TC to the lowest TC in 5 postoperative days （ PRETC/POD5TC ） showed significant correlation with severe postoperative complications on receiver operating characteristic crave, with an area under the curve of 0.84（95% CI,0.78 - 0.90 ; P = 0. 029 ）. Using the calculated cutoff value of 1.69, PRETC/ POD5TC had a sensitivity of 73.4% and a specificity of 85.2% in the prediction of severe postoperative complications. The PRETC/POD5TC（ 〉 1.69）was also an independent prognostic factor for severe postoperative complications by multivariate analysis. Conclusion Early postoperative hypocholesterolemia is a good predictor of severe complications after hepatectomy.