MELD、ALBI和PALBI评分对肝切除术后肝衰竭的预测作用

Predictive value of multiple scoring systems on post-hepatectomy liver failure

目的探讨终末期肝病模型(MELD)、白蛋白-胆红素(ALBI)、血小板-白蛋白-胆红素(PALBI)评分对肝细胞癌患者住院期间肝切除术后肝衰竭(PHLF)的预测价值。方法回顾性分析2018年1月至2022年12月哈尔滨医科大学附属第一医院肝切除的236例肝细胞癌患者的临床资料,根据肝切除术后住院期间是否发生PHLF,将其分为PHLF组56例和非PHLF组180例。采用多因素Logistic回归模型筛选PHLF的独立危险因素,采用ROC曲线对MELD、ALBI和PALBI评分预测PHLF的效能进行比较。结果与非PHLF组比较,PHLF组MELD评分、ALBI评分、PALBI评分以及肝硬化、开放手术比例较高,剩余肝脏体积占比较低(P均<0.05)。两组年龄、性别、基础疾病均无统计学差异(P>0.05)。MELD评分(OR=1.489,95%CI:1.102~2.011)、ALBI评分(OR=1.618,95%CI:1.177~2.224)、PALBI评分(OR=1.872,95%CI:1.273~2.753)是肝细胞癌患者发生PHLF的独立危险因素。PALBI评分预测肝细胞癌患者发生PHLF的AUC为0.871(95%CI:0.820~0.923),显著高于ALBI评分的0.751(95%CI:0.673~0.830)及MELD评分的0.638(95%CI:0.557~0.720),差异均有统计学意义(P<0.05)。结论术前MELD、ALBI和PALBI评分均是肝细胞癌患者肝切除术后住院期间发生PHLF的独立危险因素,对PHLF具有一定程度的预测效能,其中以PALBI评分的预测价值最高。

Objective To compare the predictive value of commonly used liver function evaluation systems in post-hepatectomy liver failure(PHLF)in patients with hepatocellular carcinoma.Methods Retrospective analysis of clinical data from 236 patients with hepatocellular carcinoma who underwent liver resection at the First Affiliated Hospital of Harbin Medical University from January 2018 to December 2022.Based on whether PHLF occurred during hospitalization after liver resection,they were divided into a PHLF group of 56 cases(23.73%)and a non PHLF group of 180 cases(76.27%).Multifactorial logistic regression analysis was used to screen the independent risk factors for PHLF,and the efficacy of the liver function evaluation system in predicting PHLF was rated using the ROC curve,and the results were expressed as AUC.Results Univariate analysis showed that compared with the non-PHLF group,the MELD score,ALBI score,PALBI score,and the proportion of cirrhosis and open surgery were higher,and the percent of remaining liver volume was significantly lower in the PHLF group(P<0.05),and there was no statistically significant difference between the two groups in terms of age,gender,and underlying diseases(P>0.05).Multifactorial logistic analysis showed that MELD score(OR=1.489,95%CI:1.102-2.011),ALBI score(OR=1.618,95%CI:1.177-2.224),and PALBI score(OR=1.872,95%CI:1.273-2.753)were the risk factors of patients with hepatocellular carcinoma.ROC curve showed that PALBI score had the highest AUC for predicting the occurrence of PHLF in patients with HCC[0.871(95%CI:0.820-0.923)],with ALBI score in the middle[0.751(95%CI:0.673-0.830)],and MELD score in the lowest[0.638(95%CI:0.557-0.720)].Conclusion MELD score,ALBI score and PALBI score were all independent risk factors for the development of PHLF in patients with hepatocellular carcinoma,and had a certain degree of predictive efficacy for PHLF,with PALBI score having the highest predictive value.