肝硬度值及标准残肝体积在肝癌半肝切除术后肝功能不全中的预测价值

Predictive value of liver stiffness measurement and standard remnant liver volume for hepatic insufficiency in hepatocellular carcinoma patients after hemihepatectomy

目的探讨肝硬度值(LSM)及标准残肝体积(SRLV)在肝细胞癌(HCC)半肝切除术后肝功能不全中的预测价值。方法回顾性分析2016年6月至2020年2月南通大学附属南通第三人民医院行半肝切除的28例HCC患者临床资料。其中男20例,女8例;平均年龄(57±9)岁。患者均签署知情同意书,符合医学伦理学规定。以肝脏瞬时弹性成像测定患者的LSM,CT测定SRLV。根据术后有否发生肝功能不全分为肝功能不全组(10例)和非肝功能不全组(18例)。术后肝功能不全的相关因素分析采用χ2检验和多因素Logistic回归,采用受试者工作特征(ROC)曲线评估LSM及SRLV预测术后肝功能不全的价值。结果肝功能不全组LSM、SRLV分别为(27±6)kPa、(267±46)ml/m^2,非肝功能不全组相应为(17±5)kPa、(366±60)ml/m^2,差异有统计学意义(t=23.730,-20.422;P<0.05)。多因素Logistic回归分析显示,LSM≥25 kPa、SRLV≤290 ml/m^2为术后肝功能不全发生的独立危险因素(OR=17.448,24.690;P<0.05)。ROC曲线分析显示,当LSM=17 kPa、SRLV=266 ml/m^2时预测术后并发症发生的敏感度和特异度最佳,ROC曲线下面积分别为0.894、0.903(Z=6.684,6.763;P<0.05)。结论术前LSM和SRLV检测对HCC半肝切除术后肝功能不全有较高的预测价值。

Objective To assess the predictive value of liver stiffness measurement(LSM)and standard remnant liver volume(SRLV)for hepatic insufficiency in hepatocellular carcinoma(HCC)patients after hemihepatectomy.Methods Clinical data of 28 HCC patients who underwent hemihepatectomy in Nantong Third People's Hospital Affiliated to Nantong University from June 2016 to February 2020 were retrospectively analyzed.Among them,20 patients were male and 8 female,aged(57±9)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.LSM was measured by transient elastography,and SRLV was measured by CT scan.According to the incidence of hepatic insufficiency,all patients were divided into the hepatic insufficiency(n=10)and nonhepatic insufficiency(n=18)groups.The risk factors for postoperative hepatic insufficiency were identified by Chi-square test and multivariate Logistic regression analysis.The predictive value of LSM and SRLV for postoperative hepatic insufficiency was evaluated by the receiver operating characteristic(ROC)curve.Results In the hepatic insufficiency group,LSM and SRLV were(27±6)kPa and(267±46)ml/m^2,which significantly differed from(17±5)kPa and(366±60)ml/m^2 in the non-hepatic insufficiency group(t=23.730,-20.422;P<0.05).Multivariate Logistic regression analysis showed that LSM≥25 kPa and SRLV≤290 ml/m^2 were the independent risk factors for postoperative hepatic insufficiency(OR=17.448,24.690;P<0.05).ROC curve analysis demonstrated that LSM=17 kPa and SRLV=266 ml/m^2 yielded the highest sensitivity and specificity in predicting postoperative complications,and the areas under ROC curve were 0.894 and 0.903(Z=6.684,6.763;P<0.05).Conclusions Preoperative detection of LSM and SRLV can be utilized to predict hepatic insufficiency in HCC patients after hemihepatectomy.