常规肝功能检测在大肝癌切除术肝储备功能评估中的临床价值

Clinical value of the conventional liver function test in liver reserve function assessment for large hepatocellular carcinoma

目的 探讨常规肝功能检测在大肝癌切除术肝储备功能评估中的临床价值.方法 收集2014年1月-2016年12月在解放军福州总医院肝胆外科行大肝癌切除术的113例Child-PughA级肝细胞癌患者的临床病例资料进行回顾性分析.按术后肝功能恢复情况不同分为两组,其中肝功能恢复良好组105例,肝功能代偿不全组8例.观察比较两组患者的肝功能指标.近似正态分布的计量资料以均数±标准差((x)±s)表示,组间比较采用t检验;偏态分布或方差不齐的计量资料以M(范围)表示,组间比较采用Man-Whitney U检验;计数资料比较采用Fisher精确检验;Logistic单因素及多因素分析术后肝功能代偿不全的危险因素并绘制ROC曲线.结果 两组患者术前凝血酶原时间、国际标准化比值、血小板、前白蛋白、总胆红素、碱性磷酸酶、γ-谷氨酰转肽酶组间比较,差异均存在统计学意义(Z值分别为-1.983、-2.180、-2.608、-2.007、-3.577、-2.228、-2.575,P＜0.05).Logistic单因素分析显示,血小板、总胆红素、前白蛋白是影响大肝癌切除术后肝功能恢复的危险因素.Logistic多因素回归分析显示,术前高总胆红素、低前白蛋白是大肝癌切除术后肝功能代偿不全的独立危险因素.Logistic单因素分析显示,术前高总胆红素、低前白蛋白不是大肝癌切除术后肝功能衰竭的危险因素.ROC曲线评估得出总胆红素的曲线下面积为0.880,P=0.000,95％CI:0.808 ～0.953,敏感度为87.5％,特异度为84.8％;前白蛋白的曲线下面积为0.769,P=0.011,95％ CI:0.648 ～0.891,敏感度为75.2％,特异度为77.5％.ROC曲线评估得出大肝癌切除术后预测肝功能代偿不全的总胆红素和前白蛋白最佳阈值分别为17.55 μmol/L和0.18 g/L.结论 Child-Pugh A级肝细胞癌患者行大肝癌切除术,术前总胆红素＜17.55 μmol/L且前白蛋白≥0.18 g/L时,术后肝功能恢复良好.

Objective To study the clinical value of the conventional liver function tests in liver reserve function assessment for large hepatocellular carcinoma.Methods The clinicopathological data of 113 patients with ChildPugh A hepatocellular carcinoma who underwent radical resection with large hepatocellular carcinoma in the Department of Hepatobiliary Surgery of Fuzhou General Hospital of People's Liberation Army from January 2014 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to the recovery of postoperative liver function,which 105 patients recovered well and 8 patients had hepatic decompensation among them.The liver function index of two groups were analyzed.Measurement data with approximately normal distribution were represented by and groups were compared using t test;measurement data with skewed or uneven disstribution were represented by M (range)and group werecompared using Man-Whitney U test;count data were compared using Fisher exact test;risk factors for postoperative liver dysfunction were analyzed using Logistic single factor and multivariate and ROC curve were drawn.Results Preoperative prothrombin time,international standardization ratio,platelet,prealbumin,total bilirubin,alkaline phosphatase,γ-glutamyl transpeptidase comparison between the two groups were statistically significant (Z =-1.983,-2.180,-2.608,-2.007,-3.577,-2.228,-2.575,P ＜ 0.05).Logistic univariate analysis showed that platelet,total bilirubin and prealbumin were the risk factors for the recovery of liver function of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic multivariate regression analysis showed that preoperative high total bilirubin and low preabumin were independent risk factors of radical resection hepatic decompensation with large hepatocellular carcinoma.Logistic univariate analysis showed that preoperative high total bilirubin and low prealbumin were not risk factors of radical resection liver failure with large hepatocellular carcinoma.The area under the curve of total bilirubin was 0.880,P =0.000,95％ CI:0.808-0.953,the sensitivity was 87.5％,specificity was 84.8％ and the area under prealbumin curve was 0.769,P =0.011,95％ CI:0.648-0.891,sensitivity was 75.2％,specificity was 77.5％ by the ROC curve.The best threshold of total bilirubin and prealbumin after radical resection with large hepatocellular carcinoma were 17.55 μmol/L and 0.18 g/L respectively by the ROC curve.Conclusion The Child-Pugh A patients in radical resection hepatic decompensation with large hepatocellular carcinoma recover well when the preoperative liver function is as follows:total bilirubin ＜ 17.55 μmol/L and prealbumin ≥0.18 g/L.