白蛋白-胆红素评分联合标准化残肝体积比对肝细胞癌患者肝切除术后肝功能衰竭的预测价值

Value of combining albumin-bilirubin score with standardized future liver remnant in predicting post-hepatectomy liver failure of patient with hepatocellular carcinoma

目的分析影响肝细胞癌患者肝切除术后肝功能衰竭发生的危险因素并探讨白蛋白-胆红素(ALBI)评分联合标准化残肝体积比(s FLR)在预测肝切除术后肝功能衰竭发生中的应用价值。方法收集2016年1月至2018年6月期间于兰州大学第一医院普外二科和普外五科因肝细胞癌行肝切除术治疗患者的临床资料,运用logistic回归模型分析肝切除术后肝功能衰竭发生的影响因素,用受试者工作特征(ROC)曲线分析比较ALBI评分、s FLR及ALBI评分×s FLR对肝切除术后肝功能衰竭发生的预测能力。结果本研究共纳入符合研究条件的肝细胞癌肝切除术后患者72例,均为Child-Pugh分级A级,肝切除术后肝功能衰竭发生率为27.78%(20/72),其中ALBI-Ⅰ级患者54例,ALBI-Ⅱ级患者18例,ALBI-Ⅰ级患者术后肝功能衰竭发生率明显低于ALBI-Ⅱ级患者[12.96%(7/54)比72.22%(13/18),P<0.001]。术后肝功能衰竭发生的多因素分析结果显示,血小板计数(OR=0.030,P=0.018)、ALBI分级(OR=11.758,P=0.020)及s FLR(OR=0.839,P=0.003)是影响肝细胞癌患者肝切除术后肝功能衰竭发生的独立影响因素。ALBI评分×sFLR对应的ROC曲线下面积(AUC)为0.892,其诊断效果好于ALBI评分(AUC=0.799)和s FLR(AUC=0.773)。结论相较于Child-Pugh分级,ALBI分级预测肝细胞癌患者肝切除术后肝功能衰竭发生的效果更准确,且ALBI评分×s FLR预测价值更优于单独ALBI评分或sFLR。

Objective To analyze factors affecting post-hepatectomy liver failure (PHLF) of patients with hepatocellular carcinoma (HCC) and explore value of combining albumin-bilirubin (ALBI) score with standardized future liver remnant (sFLR) in prediction of PHLF. Methods The clinical data of patients with HCC underwent curative hepatectomy in the Second and the Fifth Departments of General Surgery of the First Hospital of Lanzhou University from January 2016 to June 2018 were retrospectively reviewed. The risk factors of PHLF were identified through the logistic regression, the area under the receiver operating characteristic curve (AUC) was used to analyze the predictive value of the ALBI score, sFLR, or ALBI scorexsFLR. Results A total of 72 patients with HCC were enrolled, all of them were the Child-Pugh A grade. The incidence of PHLF was 27.78%(20/72) in these 72 patients with HCC, which was 12.96%(7/54) and 72.22%(13/18) in the 54 patients with ALBI-I grade and 18 patients with ALBI-Ⅱ grade respectively, the difference was statistically significant (P<0.001). The results of multivariable analysis of PHLF showed that the PLT (OR=0.030, P=0.018), ALBI grade (OR=1 1.758, P=0.020), and sFLR (OR=0.835, P=0.003) were identified as the independent predictors of PHLF. The AUC for the ALBI scorexsFLR in predicting the PHLF was 0.892, it was greater than that of the ALBI score (AUC=0.799) or the sFLR (AUC=0.773). Conclusion Compared with Child-pugh grade, ALBI grade is more accurate in predicting PHLF of HCC patients, and combining ALBI score with sFLR is better than sFLR or ALBI score alone in predicting PHLF of patients with HCC.