摘要
目的比较白蛋白-吲哚菁绿(ALICE)评分、白蛋白-胆红素(ALBI)评分和Child-Pugh评分预测肝细胞癌患者肝切除术后肝功能衰竭(PHLF)的能力,探讨ALICE评分的临床应用价值。方法回顾性分析2015年6月至2021年6月浙江大学附属金华医院肝胆胰外科行根治性手术切除的397例肝细胞癌患者资料,其中男性350例,女性47例,年龄(58.9±11.2)岁。单因素和多因素logistic回归分析PHLF的危险因素。受试者工作特征(ROC)曲线比较ALICE评分、ALBI评分及Child-Pugh评分对PHLF的预测能力。结果发生PHLF患者74例,未发生PHLF患者323例。多因素logistic回归分析,Child-Pugh评分(OR=1.630,95%CI:1.251~2.486,P=0.034)、ALBI评分(OR=1.863,95%CI:1.028~3.119,P=0.049)、ALICE评分(OR=1.759,95%CI:1.216~3.078,P=0.038)是肝细胞癌患者发生PHLF的独立危险因素,PHLF发生风险随着评分分级升高而升高。ALICE评分预测肝细胞癌患者PHLF的ROC曲线下面积为0.613(95%CI:0.564~0.662),ALBI评分ROC曲线下面积0.612(95%CI:0.563~0.661),Child-Pugh评分ROC曲线下面积0.555(95%CI:0.505~0.605),ALICE评分优于Child-Pugh评分,差异有统计学意义(z=2.04,P=0.041)。在小范围肝切除患者中,ALICE评分预测PHLF的ROC曲线下面积也优于Child-Pugh评分,差异有统计学意义(z=2.61,P=0.009);ALICE评分与ALBI评分比较,差异无统计学意义(z=0.06,P=0.954)。结论ALICE评分能够预测肝细胞癌患者PHLF的发生,尤其是在小范围肝切除患者中,其价值与ALBI评分相近,且优于Child-Pugh评分。
Objective To investiagte the ability of albumin-indocyanine green(ALICE)score,albumin-bilirubin(ALBI)score and Child-Pugh score in predicting postoperative liver failure(PHLF)in patients with hepatocellular carcinoma,and to determine the clinical value of ALICE score.Methods The clinical data of 397 patients with hepatocellular carcinoma who underwent hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery,Jinhua Hospital Affiliated to Zhejiang University from June 2015 to June 2021 were retrospectively analyzed,including 350 males and 47 females,aged(58.9±11.2)years.Univariate and multivariate logistic regression were used to analyze the risk factors of PHLF.The predictive ability of ALICE score for PHLF was evaluated by receiver operating characteristic(ROC)curve,and compared with ALBI score and Child-Pugh score.Results There were 74 patients with PHLF and 323 patients without PHLF.Multivariate logistic regression analysis showed that Child-Pugh score(OR=1.630,95%CI:1.251-2.486,P=0.034),ALBI score(OR=1.863,95%CI:1.028-3.119,P=0.049)and ALICE score(OR=1.759,95%CI:1.216-3.078,P=0.038)were independent risk factors for PHLF in patients with hepatocellular carcinoma,and the risk of PHLF increased with the increase of grade.The area under the ROC curve of ALICE score predicting PHLF in patients with hepatocellular carcinoma was 0.613(95%CI:0.564-0.662),the area under the ALBI score was 0.612(95%CI:0.563-0.661),and the area under the Child-Pugh score was 0.555(95%CI:0.505-0.605).The ALICE score was better than the Child-Pugh score,and the difference was statistically significant(z=2.04,P=0.041).In small liver resection patients,ALICE score was better than Child-Pugh score(z=2.61,P=0.009).There was no significant difference betwenn ALICE score and ALBI score(z=0.06,P=0.954).Conclusion ALICE score can predict the occurrence of PHLF in patients with hepatocellular carcinoma,especially in patients with small liver resection,its value is similar to ALBI score,but better than Child-Pugh score.
作者
陈敏强
尹梦秋
吴波
李仓
厉学民
吴晓康
胡伟建
周海华
程俊峰
俞世安
Chen Minqiang;Yin Mengqiu;Wu Bo;Li Cang;Li Xuemin;Wu Xiaokang;Hu Weijian;Zhou Haihua;Cheng junfeng;Yu Shian(Department of Hepatobiliary and Pancreatic Surgery,Jinhua Hospital Affiliated to Zhejiang University,Jinhua 321000,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2022年第9期646-650,共5页
Chinese Journal of Hepatobiliary Surgery
基金
浙江省公益基金研究项目(LGF20H160028)
金华市科技计划项目重大项目(2018-3-001a)。
关键词
癌
肝细胞
肝切除术
肝功能衰竭
吲哚菁绿
白蛋白-胆红素
Carcinoma,hepatocellular
Hepatectomy
Liver failure
Indocyanine green
Albumin-bilirubin
