术前血小板与淋巴细胞比值对肝切除术后肝衰竭的预测价值

Predictive value of preoperative platelet-to-lymphocyte ratio for post-hepatectomy liver failure

目的:探讨术前血小板与淋巴细胞比值(PLR)对肝切除术后肝衰竭(PHLF)的预测价值。方法:回顾性分析2014年1月至2019年5月在新疆医科大学第一附属医院行肝切除术的297例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男157例,女140例;年龄10~76岁,中位年龄43岁。根据是否发生PHLF,将患者分为PHLF组(43例)与非PHLF组(254例)。PHLF发生影响因素的单因素分析采用t检验、秩和检验或χ^(2)检验,多因素分析采用Logistic回归分析。采用ROC曲线分析评估术前PLR水平对PHLF的预测价值。结果:单因素分析显示,PHLF发生与患者手术方式、肝切除范围、HBV感染、合并腹腔积液密切相关(χ^(2)=12.181,9.413,3.565,12.125;P<0.10),与手术时间、术中出血量、INR、PLR亦相关(Z=3.847,5.211,2.561,-3.452;P<0.10)。多因素Logistic回归分析显示,PLR、手术时间、合并腹腔积液为PHLF的独立危险因素(OR=0.975,1.003,3.154;P<0.05)。PLR预测PHLF的ROC曲线下面积为0.665(95%CI:0.597~0.733),PLR最佳截断值为161,敏感度和特异度分别为1.000和0.594。终末期肝病模型(MELD)评分对PHLF预测的曲线下面积为0.612,与PLR比较差异无统计学意义(Z=2.352,P>0.05)。结论:术前PLR可作为评估PHLF的临床指标,具有良好的预测效能,敏感度较高,可达到MELD评分相同的预测价值。

Objective To evaluate the predictive value of preoperative platelet-to-lymphocyte ratio(PLR)for post-hepatectomy liver failure(PHLF).Methods Clinical data of 297 patients who underwent hepatectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2014 to May 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,157 patients were male and 140 female,aged from 10 to 76 years,with a median age of 43 years.According to the incidence of PHLF,all patients were divided into the PHLF(n=43)and non-PHLF groups(n=254).Univariate analysis of influencing factors of PHLF was conducted by t test,rank-sum test or Chi-square test.Multivariate analysis was performed by Logistic regression analysis.The predictive value of preoperative PLR for PHLF was evaluated by the receiver operating characteristic(ROC)curve analysis.Results Univariate analysis showed that the incidence of PHLF was correlated with the operative procedure,range of hepatectomy,HBV infection and ascites(χ^(2)=12.181,9.413,3.565,12.125;P<0.10),which was also correlated with the operation time,intraoperative blood loss,INR and PLR(Z=3.847,5.211,2.561,-3.452;P<0.10).Multivariate Logistic regression analysis revealed that PLR,operation time and ascites were the independent risk factors for PHLF(OR=0.975,1.003,3.154;P<0.05).The area under ROC curve(AUC)of PLR for predicting PHLF was 0.665(95%CI:0.597-0.733),the optimal cutoff value of PLR was 161,and the sensitivity and specificity were 1.000 and 0.594.The AUC of Model for End-stage Liver Disease(MELD)score for predicting PHLF was 0.612,and there was no significant difference compared with PLR(Z=2.352,P>0.05).Conclusions Preoperative PLR can be used as a clinical index to evaluate PHLF.It yields high predictive efficiency and high sensitivity,which can achieve equivalent predictive value as MELD score.