总胆红素白蛋白比值与原发性肝癌腹腔镜术后复发的关系

Relationship between ratio of total bilirubin to albumin and recurrence of primary hepatic carcinoma after laparoscopic surgery

目的探讨总胆红素(total bilirubin,TBIL)白蛋白(albumin,ALB)比值与原发性肝癌(primary health care,PHC)腹腔镜术后复发的关系。方法本研究采用前瞻性分析,纳入2019年1月—2021年1月漯河医学高等专科学校第三附属医院收治的98例PHC患者为研究对象,均行腹腔镜肝切除术治疗,观察患者术前TBIL、ALB及TBIL/ALB水平,术后随访2年,观察PHC患者术后复发情况,使用点二列相关性分析PHC患者术前TBIL/ALB水平与术后复发的关系,受试者工作特征曲线(receiver operating curve,ROC),评估术前TBIL/ALB水平对PHC患者腹腔镜术后复发的预测价值。结果腹腔镜肝切除术后随访2年发现,98例PHC患者中有52例患者复发,占比53.06%,有46例患者未发复发,占比46.94%。两组PHC患者年龄、性别、中国肝癌分期(CNCL分期)、Child-pugh分级及肿瘤直径大小比较,差异无统计学意义(P>0.05);复发组患者与未复发组患者血清谷草转氨酶(glutamic oxaloacetic transaminase,GOT)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、纤维蛋白原(fibrinogen,FIB)、凝血活酶时间(activated partial thromboplastin time,APTT)、血清癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原125(carbohydrate anti-gen 125,CA125)、糖类抗原199(carbohydrate antigen 199,CA199)水平比较,差异无统计学意义(P>0.05);复发组血清TBIL、TBIL/ALB及甲胎蛋白(alpha-fetoprotein,AFP)水平明显高于未复发组,而血清ALB水平明显低于未复发组,差异有统计学意义(P<0.05);经点二列相关性分析结果发现,术前TBIL/ALB及AFP水平与PHC患者腹腔镜术后复发呈正相关(r>0,P<0.05);绘制ROC曲线,结果显示,术前TBIL/ALB水平预测PHC患者腹腔镜术后复发的曲线下面积(area under curve,AUC)>0.7,具有一定的预测价值。结论术前TBIL/ALB水平与PHC患者腹腔镜术后复发有密切关系,且其对PHC患者腹腔镜术后复发具有预测价值。

Objective To investigate the relationship between the ratio of total bilirubin(TBIL)to albumin(ALB)and the recurrence of primary hepatic carcinoma(PHC)after laparoscopic surgery.Methods This study used a prospective analysis,98 patients with PHC admitted to the hospital from January 2019 to January 2021 were selecet-ed as the study subjects,all of them underwent laparoscopic hepatectomy.The levels of TBIL,ALB and TBIL/ALB before operation were observed.The patients were followed up for 2 years after operation to observe the recurrence of PHC patients after operation.The relationship between preoperative TBIL/ALB level and postoperative recur-rence of PHC patients was analyzed by point two column correlation.The receiver operating characteristic curve(ROC curve)was drawn to evaluate the predictive value of preoperative TBIL/ALB level for recurrence of PHC pa-tients after laparoscopic surgery.Results Duringa 2-year follow-up after laparoscopic hepatectomy,52 of 98 PHC patients(53.06%)experienced recurrence,while 46 patients(46.94%)did not experience recurrence.There was no statistical significant difference between the two groups in age,gender,Chinese liver cancer stage(CNCL stage),Child-pugh grade,and tumor diameter(P>0.05).There was no statistical significant differ-ence in serum levels of glutamic oxaloacetic transaminase(GOT),alanine aminotransferase(ALT),fibrinogen(FIB),prothrombin time(APTT),carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA125),and carbohydrate antigen 199(CA199)between patients in the recurrent group and those in the non recurrent group(P>0.05).The serum TBIL,TBIL/ALB,and alpha fetoprotein(AFP)levels in the recurrent group were signif-icantly higher than those in the non recurrent group,while the serum ALB levels were significantly lower than those in the non recurrent group,with a statistical significant difference(P<0.05).The results of point binary correla-tion analysis showed that preoperative TBIL/ALB and AFP levels were positively correlated with postoperative recur-rence in PHC patients after laparoscopic surgery(r>0,P<0.05).The ROC curve was plotted,and the results showed that the preoperative TBIL/ALB level had a predictive value in predicting the area under the curve(AUC)of postoperative recurrence in PHC patients with laparoscopic surgery,which was greater than 0.7.Conclusion Thepreoperative TBIL/ALB level is closely related to the recurrence of PHC patients after laparoscop-ic surgery,and it has predictive value for the recurrence of PHC patients after laparoscopic surgery.