基于二维剪切波弹性成像预测原发性肝细胞癌切除术后肝衰竭的价值

Value of predicting liver failure after primary hepatocellular carcinoma resection based on two-dimensional shear wave elastography

目的探讨二维剪切波弹性成像(2D-SWE)预测原发性肝细胞癌切除术后肝衰竭的价值,帮助医师判断预后。方法回顾性分析2021年5月—2022年5月在浙江省荣军医院及浙江省中医院行原发性肝细胞癌切除术的180例患者的临床资料,根据术后是否发生肝衰竭分为肝衰竭组(35例)和非肝衰竭组(145例)。患者术前接受实验室和2D-SWE检查,经单因素分析和多因素logistic回归分析筛选出预测原发性肝细胞癌切除术后肝衰竭的危险因素,并分析其预测价值。结果单因素分析结果显示,肝衰竭组和非肝衰竭组在白蛋白、总胆红素、谷草转氨酶、γ-谷氨酰转移酶、凝血酶原时间、国际标准化比值及Child-Pugh评分、终末期肝病模型(MELD)评分、肿瘤大小、有肝门阻断、肝脏硬度值的差异有统计学意义(均P<0.05)。经多因素logistic回归分析,国际标准化比值、肿瘤大小、肝脏硬度值是原发性肝细胞癌切除术后肝衰竭的独立影响因素(OR=5.078、4.943、5.073,均P<0.05)。经ROC曲线分析,国际标准化比值、肿瘤大小、肝脏硬度值预测原发性肝细胞癌切除术后肝衰竭的曲线下面积为0.791、0.829、0.994,预测效能较好。结论基于2D-SWE预测原发性肝细胞癌切除术后肝衰竭的临床价值较高,国际标准化比值在1.01及以上、肿瘤大小在4.82 cm及以上、肝脏硬度值在10.66 kPa及以上是原发性肝细胞癌切除术后肝衰竭的独立危险因素。

Objective To explore the value of two-dimensional shear wave elastography(2D-SWE)in predicting liver failure after resection of primary hepatocellular carcinoma(HCC)and to help doctors judge the prognosis.Methods The clinical data of 180 patients who underwent primary hepatocellular carcinoma resection in Zhejiang Provincial Veterans'Hospital and Zhejiang Provincial Hospital of Traditional Chinese Medicine from May 2021 to May 2022 were analyzed retrospectively.They were divided into liver failure group(35 cases)and non-liver failure group(145 cases)according to whether there was liver failure after surgery.The patients received laboratory and 2D-SWE examination before operation.Through univariate analysis and multivariate logistic regression analysis,the risk factors for predicting liver failure after primary hepatocellular carcinoma resection were screened,and their predictive value was analyzed.Results Univariate analysis showed that there were significant differences in albumin,total bilirubin,aspartate aminotransferase,γ-glutamyltransferase,prothrombin time,international standardized ratio and Child Pugh score,model for end-stage liver disease(MELD)score,tumor size,hepatic portal occlusion,and liver hardness(all P<0.05).Multivariate logistic regression analysis showed that international standardized ratio,tumor size and liver hardness were independent risk factors for liver failure after resection of primary hepatocellular carcinoma(OR=5.078,4.943,5.073,all P<0.05).The ROC curve analysis results showed that the area under the curve for predicting liver failure after primary hepatocellular carcinoma resection using international standardized ratios,tumor size,and liver hardness values were 0.791,0.829 and 0.994,with good prediction efficiency.Conclusion The clinical value of predicting liver failure after primary hepatocellular carcinoma resection based on 2D-SWE is high.International standardized ratios of 1.01 and above,tumor sizes of 4.82 cm and above,and liver hardness values of 10.66 kPa and above are independent risk factors for liver failure after primary hepatocellular carcinoma resection.