ALBI联合剩余肝体积对HBV相关原发性肝癌患者肝切除术后肝衰竭发生的预测价值

Value of ALBI and future liver remnant combinationin predicting the occurrence of post-hepatectomy liver failure in patients with hepatocellular carcinoma

目的评价联合应用白蛋白-胆红素(ALBI)评分和剩余肝体积(FLR)预测肝细胞癌(HCC)患者发生肝切除术后肝功能衰竭(PHLF)的价值。方法2015年10月~2019年5月我院收治的HCC患者76例,术前行腹部三维CT重建,由软件计算全肝体积和剩余肝体积(FLR),行白蛋白-胆红素(ALBI)评分,均接受肝切除术。采用单因素和多因素Logistic回归分析影响HCC患者发生PHLF的相关因素,应用受试者工作特征曲线(ROC)分析,确定PHLF发生的独立预测因素。结果在76例HCC患者中发生PHLF 28例,未发生PHLF 48例;非PHLF组年龄为(48.2±6.3)岁,显著小于PHLF组[(55.9±7.1)岁,P<0.05],INR为(0.9±0.1),显著低于PHLF组[(1.1±0.1),P<0.05],血清白蛋白为(40.6±3.2)g/L,显著高于PHLF组[(36.4±3.1)g/L,P<0.05],血小板计数为(241.2±80.3)×10^9/L,显著高于PHLF组[(181.9±60.8)×10^9/L,P<0.05],ALBI评分为(-2.9±0.8)分,显著低于PHLF组[(-1.8±1.0)分,P<0.05],MELD评分为(7.0±1.5)分,显著低于PHLF组[(8.4±1.9)分,P<0.05],Child-Pugh评分为(4.2±1.2)分,显著低于PHLF组[(5.8±1.4)分,P<0.05],FLR为(890.6±210.6)cm 3,显著大于PHLF组[(720.1±180.7)cm 3,P<0.05];多因素Logistic回归分析提示ALBI评分和FLR是HCC患者发生PHLF的独立预测因素(P<0.05);ALBI联合FLR诊断HCC患者发生PHLF的敏感度和特异度分别为81.2%和90.5%。结论联合应用ALBI和FLR评估HCC患者肝脏储备功能有助于防止PHLF的发生,对提高手术成功率有重要的临床意义。

Objective The purpose of this study was to evaluate the value of albumin-bilirubin(ALBI)score and future liver remnant(FLR)combination in predicting the occurrence of post-hepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma(HCC).Methods A total of 76 patients with HCC were recuited in our hospital between October 2015 and May 2019,and ALBI were obtained.All the patients underwent abdominal three-dimensional CT reconstruction and hepatectomy.Univariate and multivariate Logistic regression analysis were applied to explore the clinical influencing factors related to the occurrence of PHLF.The diagnostic values of the related index for the occurrence of PHLF were determined by receiver operating characteristic curve.Results Out of the 76 patients with HCC,28 had PHLF and 48 hadn’t;the average age of patients with non-PHLF was(48.2±6.3)years,significantly younger than[(55.9±7.1)years,P<0.05],the INR was(0.9±0.1),significantly lower than[(1.1±0.1),P<0.05],serum albumin level was(40.6±3.2)g/L,significantly higher than[(36.4±3.1)g/L,P<0.05],blood platelet count was(241.2±80.3)×10^9/l,significantly higher than[(181.9±60.8)×10^9/l,P<0.05],the ALBI score was(-2.9±0.8),significantly lower than[(-1.8±1.0),P<0.05],the MELD score was(7.0±1.5),significantly lower than that[(8.4±1.9),P<0.05],the Child-Pugh score was(4.2±1.2),significantly lower than[(5.8±1.4),P<0.05],and the FLR was(890.6±210.6)cm 3,significantly larger than[(720.1±180.7)cm 3,P<0.05]in patients without PHLF;multivariate Logistic regression analysis showed that ALBI score and and FLR were the independent predictors of PHLF occurrence in patients with HCC(P<0.05);the sensitivity and specificity of ALBI and FLR combination in diagnosing PHLF in patients with HCC were 81.2%and 90.5%.Conclusion The application of ALBI and FLR for evaluating liver reserve function in patients with HCC before hepatectomy is feasible,and might guide the clinicians to make decisions and prevent the occurrence of PHLF.