白蛋白与球蛋白比值对肝癌患者术后生存预后的影响

Prognostic significance of albumin/globulin ratio on postoperative survival of patients with hepatocellular carcinoma

目的探究白蛋白与球蛋白比值（A／G）对肝癌（HCC）患者术后生存预后的影响及其临床价值。方法回顾性分析2009年2月至2013年7月收治的行手术切除的630例HCC患者资料。根据A／G的正常下限值将患者分为低值组（A／G〈1．5，简称L组）和高值组（A／G≥1．5，简称H组），并观察其分布特征。应用Cox单因素和多因素回归分析影响患者生存预后的独立危险因素；Kaplan—Meier法分析所有患者和巴塞罗那分期（BCLC分期）A、B、C各期低值组和高值组的生存趋势。结果多因素分析显示：术前A／G（P=0．007）、甲胎蛋白水平（P〈0．001）、γ-谷氨酰转移酶水平（P=0．006）、红细胞计数（P=0．014）、国际标准化比值（P=0．009）、术前BCLC分期（P〈0．001）及肿瘤数目（P=0．003）、术中输血（P〈0．001）状态是HCC患者术后长期生存的独立影响因素。在630例患者中，L组总生存（OS）的中位生存时间仅为15个月，显著低于H组的42个月（P〈0．001）。分层分析显示：A／G高值组患者的近期生存优势仅限于BCLCA期患者（P〈0．001），在B期和C期患者中消失（P〉0．05）；而远期生存优势则存在于BCLCA（P〈0．001）和B期中（P〈0．05），在C期患者中消失（P〉0．05）。结论术前A／G能够预测HCC患者预后，指导早期HCC患者的治疗，是一个具有较高临床应用价值的指标。

Objective To investigate the prognostic value of albumin/globulin ratio on postoperative survival outcomes in patients with hepatocellular carcinoma. Methods Data of 630 patients with HCC, who underwent surgical resection from February 2009 to July 2013, were retrospectively analyzed. Patients were divided into low-value group （A/G 〈 1.5, defined as L group） and high-value group （A/G ≥ 1.5, defined as H group）, and their distribution characteristics were observed with the normal A/G threshold value. Independent risk factors＇ affecting survival and prognosis was analyzed with univariate and multivariate Cox＇s regressionmodel. Survival trend of all patients with low-value and high-value groups in A, B and C of Barcelona stage （BCLC stage） were analyzed using the Kaplan-Meier method. Results Multivariate analysis showed that preoperative A/G ratio （P = 0.007）, alpha-fetoprotein （P 〈 0.001）, gamma-glutamyltransferase （P = 0.006）, RBC （P = 0.014）, international normalized ratio （P = 0.009）, preoperative BCLC staging （P 〈 0.001） and number of tumors （P = 0.003）, and intraoperative blood transfusion （P 〈 0.001） were independent prognostic factors affecting long-term survival in HCC patients. The median overall survival time in-group L was 15 months, significantly lower than that in group H of 42 months （P 〈 0.001）. Stratified analysis showed that the short-term survival advantage of patients with high A/G value was limited to those with Barcelona stage A （P 〈 0.001）, and disappeared in patients with Barcelona stage B and C （P 〉 0.05）. The long-term survival advantage existed in patients with Barcelona stage A （P 〈 0.001）, B （P 〈 0.05）, and disappeared in C （P 〉 0.05）. Conclusion Preoperative albumin/globulin ratio can predict postoperative prognosis and survival, and direct towards the treatment for early stage of HCC and thus representing as an indicator of high clinical value.