抗凝血酶Ⅲ在预测肝细胞癌术后肝衰竭中的应用价值

Value of antithrombin Ⅲ in prediction of liver failure after hepatocellular carcinoma operation

目的 探讨肝细胞癌患者术前血清抗凝血酶Ⅲ(AT-Ⅲ)在预测术后发生肝功能衰竭的应用价值.方法 将本院接受肝癌手术的31例患者根据术后肝功能恢复情况分为肝衰竭组(n=7)和非衰竭组(n=24).比较2组常规肝功能指标及AT-Ⅲ活性,探讨影响肝癌术后肝功能衰竭的危险因素.结果 2组总胆红素、AT-Ⅲ活性、白蛋白、血小板、国际标准化比值差异有统计学意义(P<0.05).Logistic多因素分析显示,总胆红素、AT-Ⅲ是术后肝衰竭的独立危险因素(P<0.05).ROC曲线分析表明,AT-Ⅲ预测术后肝功能衰竭的最佳临界值为87.2%,其灵敏度和特异度分别为0.807和0.716,与血清总胆红素相比差异有统计学意义(P<0.05).结论 AT-Ⅲ是肝癌术后发生肝衰竭的独立危险因素,其在预测术后肝衰竭的灵敏度和特异度较血清总胆红素高.

Objective To explore the application value of preoperative serum antithrombinⅢ(AT-Ⅲ)in predicting postoperative liver failure in patients with hepatocellular carcinoma.Methods A total of 31 patients who underwent liver cancer surgery in our hospital were divided into hepatic failure group and non-failure group according to the recovery of liver function after hepatectomy.The routine liver function indexes and AT-Ⅲactivity were compared between the two groups,and the risk factors of hepatic failure after hepatectomy were explored.Results There were significant differences in total bilirubin,AT-Ⅲactivity,albumin,platelet and international standardized ratio between the two groups(P<0.05).Logistic multivariate analysis showed that total bilirubin and AT-Ⅲwere independent risk factors of liver failure after hepatectomy(P<0.05).ROC curve analysis showed that the best critical value of AT-Ⅲfor predicting liver failure after operation was 87.2%.The sensitivity and specificity were 0.807 and 0.716,respectively,which showed a significant difference compared with serum total bilirubin(P<0.05).Conclusion AT-Ⅲis an independent risk factor for hepatic failure after hepatocellular carcinoma operation,which has higher sensitivity and specificity in predicting hepatic failure after operation than serum total bilirubin.