C反应蛋白与白蛋白比值对原发性肝癌患者预后的判断价值

Predictive Value of C-reactive Protein/Albumin Ratio on Prognosis of Patients with Primary Hepatocellular Carcinoma

目的探讨C反应蛋白(CRP)与白蛋白(Alb)比值对原发性肝癌患者预后的判断价值。方法纳入首次行手术治疗的原发性肝癌患者178例,计算术前CRP/Alb,运用受试者工作特征曲线、生存分析和Cox多元回归分析评价CRP/Alb与预后的关系。结果 CRP/Alb比值的最佳界点为0.46,敏感度为70.45%,特异度为73.97%。与低CRP/Alb组相比,高CRP/Alb组的CRP水平较高、Alb水平较低、Child-Pugh分级较高、肿瘤最长径较大、血管浸润比例较多,差异均有统计学意义(P<0.001)。Kaplan-Meier曲线显示高CRP/Alb组的生存率较低(26.8%vs.56.8%,P<0.001)。Cox多元回归分析显示CRP/Alb、Child-Pugh分级、血管浸润是预后的独立危险因素。结论术前CRP/Alb比值升高提示原发性肝癌患者预后不良,是影响患者预后的独立危险因素。

Objective To assess the prognostic value of C-reactive protein/albumin（CRP/Alb） ratio on patients with primary hepatocellular carcinoma（HCC）.Methods A total of 178 cases with HCC were enrolled.The pre-operative CRP/Alb ratio was calculated.The receiver operating characteristic curve,survival analysis and multivariate analysis were performed to identify the effect of CRP/Alb ratio on the prognosis of HCC patients.Results The best cutoff level for CRP/Alb ratio was 0.46,sensitivity was 70.45%,and specificity was 73.97%.Compared with the low CRP/Alb group,the high CRP/Alb group showed higher CRP levels,lower Alb level,higher Child-Pugh grade,larger tumor maximum diameter and larger proportion of vascular invasion,with statistical significance（P〈0.001）.The Kaplan-Meier curve displayed that lower survival rate in the high CRP/Alb group than that in low CRP/Alb group（26.8% vs.56.8%,P〈0.001）.The Cox multivariate analysis showed that CRP/Alb,Child-Pugh grade and vascular invasion were independent risk factors for the prognosis.Conclusion The elevated CRP/Alb ratio at baseline indicates poor prognosis of patients with HCC,and may be an important independent prognostic factor for the prognosis.