肝细胞癌患者血清NLR、HMGB1与肝切除术后急性肝衰竭的相关性分析

Correlation of serum NLR and HMGB1 with post-hepatectomy liver failure in patients with hepatocellular carcinoma

目的研究血清中性粒细胞/淋巴细胞比值(NLR)、高迁移率蛋白B1(MHGB1)与肝细胞癌患者肝切除术后急性肝衰竭之间的相关性。方法将十堰市太和医院2018年1月—2021年1月116例行肝切除术的肝细胞癌患者纳为研究对象,根据2011年国际肝脏外科学组(ISGLS)提出的术后肝功能衰竭相关诊断标准,统计患者术后急性肝衰竭发生情况,并将其分为肝衰竭组与非衰竭组,分别对两组患者个体因素、术前因素、术中因素以及术后因素进行对比,分析引起急性肝衰竭的相关因素,并绘绘制受试者工作特征曲线(ROC),分析术前血清NLR以及MHGB1水平在预测肝细胞癌切除术后急性肝衰竭的价值。结果116例小细胞肝癌患者肝切除术后共46例(39.66%)发生肝衰竭,其中肝衰竭A级患者共17例(36.96%),B级患者共16例(34.78%),C级患者共13例(28.26%)。肝衰竭组患者血清NLR以及HMGB1水平均显著高于未衰竭组(P<0.05)。多因素Logistic回归分析提示,Child-Puhg分级、术前NLR、HMGB1、肝切除范围以及肝阻断时间均是肝小细胞癌患者肝切除术后急性肝衰竭的独立影响因素。绘制ROC曲线发现,术前NLR超过2.16时在预测肝切除患者术后急性肝衰竭中的AUC=0.717,95%CI(0.622~0.811),术前HMGB1超过9.03μg/L时在预测肝切除患者术后急性肝衰竭中的AUC=0.838,95%CI(0.759~0.916),两指标联合应用的预测价值最高,AUC=0.900,95%CI(0.841~0.959)。结论术前血清高水平NLR及HMGB1不仅是影响肝小细胞癌患者肝切除术后急性肝衰竭的危险因素,在预测术后肝衰竭也具有一定的价值。

Objective To analyze the correlation of serum neutrophil-to-lymphocyte ratio(NLR)and high-mobility group box 1(HMGB1)with post-hepatectomy liver failure in patients with hepatocellular carcinoma.Methods 116 patients with small cell hepatocellular carcinoma who underwent hepatectomy were divided into 2 groups according to the diagnostic criteria related to post-hepatectomy liver failure proposed by the International Study Group of Liver Surgery(ISGLS):non-liver failure group(n=70)and liver failure group(n=46,39.66%,17 at grade A,16 at grade B,and 13 at grade C)and non-failure group(n=70).Peripheral venous blood samples were collectedbefore operation to detect the numbers of neutrophia and lymphocytes by automatic analyzed to calculate the NLR and to test the level of HMGB1 by ELISA.The preoperative,intraoperative and postoperative relative factors were compared between the two groups,and the factors associated with acute liver failure were screened.Meantime,receiver operating characteristic(ROC)curve was used to evaluate the value of preoperative serum NLR and MHGB1 levels in predicting posthepatectomy liver failure.Results The levels of serum NLR and HMGB1 of the liver failure group were both significantly higher than those of the non-liver failure group(both P<0.05).Multivariate Logistic regression analysis indicated that Child-Puhg grade,preoperative NLR level,preoperative HMGB1 level,extent of hepatic resection and duration of hepatic blockade were independent factors affecting post-hepatectomy liver failure in patients with small cell hepatocellular carcinoma.ROC curve found that the preoperative NLR above 2.16 had an AUC of 0.717 and the 95%CI of(0.622~0.811),and the preoperative HMGB1 above 9.03μg/L had an AUC of 0.838 and the 95%CI of(0.759~0.916),while the combined detection of the two indicators had the highest diagnostic value,with an AUC and 95%CI of 0.900 and(0.841~0.959)respectively.Conclusion Elevated preoperative serum levels of NLR and HMGB1 are risk factors for post-hepatectomy liver failure in patients with small cell hepatocellular carcinoma,and the detection of these 2 indicators is of great value in predicting post-hepatectomy liver failure.