ALBI联合APRI对HBV相关肝细胞癌肝切除术后肝衰竭发生的预测价值

Value of albumin-bilirubin score combined with aspartate aminotransferase-to-platelet ratio index in predicting the development of posthepatectomy liver failure in patients with HBV-related hepatocellular carcinoma

目的探讨血清白蛋白-胆红素评分(ALBI)联合天冬氨酸转氨酶-血小板比值(APRI)预测HBV相关肝细胞癌(HCC)肝切除术后发生肝衰竭(PHLF)的作用。方法回顾性研究广西医科大学附属肿瘤医院2006年1月-2013年10月接受肝切除术治疗的HBV相关HCC患者,将Child-Pugh评分作为对照,评估术前ALBI、APRI、ALBI联合APRI评分预测PHLF的作用。计数资料采用χ2或Fisher确切检验,采用logistic回归模型进行多变量分析识别PHLF的独立预测指标。结果纳入本研究的1055例患者中,共有151例(14.3%)发生PHLF。单、多因素分析显示,ALBI、APRI与PHLF的患者预后有显著相关性(P值均<0.001)。ALBI和APRI的受试者工作特征曲线下面积(AUC)均显著高于Child-Pugh评分(P值均<0.001)。ALBI的最佳截断值为-2.77时预测PHLF的灵敏度与特异度分别为78.1%、55.8%,ALBI>-2.77时PHLF及PHLF A/B/C的发病率明显高于该评分≤-2.77时的情况(P值均<0.001);APRI的最佳截断值为0.85时预测PHLF的灵敏度与特异度分别为61.6%、71.0%,APRI>0.85时PHLF及PHLF A/B/C的发病率明显高于该评分≤-0.85时的情况(P值均<0.001)。ALBI与APRI联合后的AUC明显高于ALBI和APRI的AUC(P值分别为<0.001和0.047)。ALBI联合APRI评分的最佳截断值为-13.10时预测PHLF的灵敏度与特异度分别为78.1%、62.2%,ALBI联合APRI评分>-13.10时的PHLF及PHLF A/B/C的发病率明显高于该评分≤-13.10时的情况(P值均<0.001)。结论 ALBI联合APRI评分可作为全新的、简便的、可靠的预测PHLF的模型。

Objective To investigate the value of albumin-bilirubin（ALBI） score combined with aspartate aminotransferase-to-platelet ratio index（APRI） in predicting the development of posthepatectomy liver failure（PHLF） in patients with HBV-related hepatocellular carcinoma（HCC）.Methods A retrospective analysis was performed for the patients with HBV-related HCC who underwent hepatectomy in The Affiliated Tumor Hospital of Guangxi Medical University from January 2006 to October 2013.With Child-Pugh score as control,the values of ALBI,APRI,and ALBI combined with APRI in predicting PHLF were analyzed.The chi-square test or the Fisher exact test was used for comparison of categorical data between groups,and the logistic regression model was used to identify independent predictive indices for PHLF.Results A total of 1055 patients were enrolled in this study,among whom 151（14.3%） experienced PHLF.The univariate and multivariate analyses showed that ALBI and APRI were significantly associated with the prognosis of PHLF patients（P〈0.001）.ALBI and APRI had a significantly higher area under the receiver operating characteristic curve（AUC） than Child-Pugh score（both P〈0.001）.ALBI had a sensitivity of 78.1% and a specificity of 55.8% in predicting PHLF at the optimal cut-off value of-2.77,and the patients with ALBI -2.77 had a significantly higher incidence rate of PHLF A/B/C than those with ALBI ≤-2.77（P〈0.001）.APRI had a sensitivity of 61.6% and a specificity of 71.0% in predicting PHLF at the optimal cut-off value of 0.85,and the patients with APRI 0.85 had a significantly higher incidence rate of PHLF A/B/C than those with APRI ≤0.85（P〈0.001）.The combination of ALBI and APRI had a significantly higher AUC than ALBI or APRI（P〈0.001 and P = 0.047）.The combination of ALBI and APRI had a sensitivity of 78.1% and a specificity of 62.2% in predicting PHLF at the optimal cut-off value of-13.10,and the patients with the combination of ALBI and APRI -13.10 had a significantly higher incidence rate of PHLF A/B/C than those with the combination of ALBI and APRI ≤-13.10（P〈0.001）.Conclusion ALBI combined with APRI can be used as a new,convenient,and reliable index for predicting PHLF.