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ALBI联合APRI对HBV相关肝细胞癌肝切除术后肝衰竭发生的预测价值
Value of albumin-bilirubin score combined with aspartate aminotransferase-to-platelet ratio index in predicting the development of posthepatectomy liver failure in patients with HBV-related hepatocellular carcinoma
文章发布日期:2018年01月05日  来源:  作者:麦荣云,叶甲舟,王言焱,等  点击次数:646次  下载次数:153次

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【摘要】:目的探讨血清白蛋白-胆红素评分 (ALBI) 联合天冬氨酸转氨酶-血小板比值(APRI)预测HBV相关肝细胞癌(HCC)肝切除术后发生肝衰竭(PHLF)的作用。方法回顾性研究广西医科大学附属肿瘤医院2006年1月-2013年10月接受肝切除术治疗的HBV相关HCC患者,将Child-Pugh评分作为对照,评估术前ALBI、APRI、ALBI联合APRI评分预测PHLF的作用。计数资料采用χ2或Fisher确切检验,采用logistic回归模型进行多变量分析识别PHLF的独立预测指标。结果纳入本研究的1055例患者中,共有151例(14.3%)发生PHLF。单、多因素分析显示,ALBI、APRI与PHLF的患者预后有显著相关性(P值均<0.001)。ALBI和APRI的受试者工作特征曲线下面积(AUC)均显著高于Child-Pugh评分(P值均<0.001)。ALBI的最佳截断值为-2.77时预测PHLF的灵敏度与特异度分别为78.1%、55.8%,ALBI>-2.77时PHLF及PHLF A/B/C的发病率明显高于该评分≤-2.77时的情况(P值均<0.001);APRI的最佳截断值为0.85时预测PHLF的灵敏度与特异度分别为61.6%、71.0%,APRI>085时PHLF及PHLF A/B/C的发病率明显高于该评分≤-0.85时的情况(P值均<0.001)。ALBI与APRI联合后的AUC明显高于ALBI和APRI的AUC (P值分别为<0.001和0.047) 。ALBI联合APRI评分的最佳截断值为-13.10时预测PHLF的灵敏度与特异度分别为78.1%、62.2%,ALBI联合APRI评分>-13.10时的PHLF及PHLF A/B/C的发病率明显高于该评分≤-13.10时的情况(P值均<0.001)。结论ALBI联合APRI评分可作为全新的、简便的、可靠的预测PHLF的模型。
【Abstract】:ObjectiveTo investigate the value of albumin-bilirubin (ALBI) score combined with aspartate aminotransferase-to-platelet ratio index (APRI) in predicting the development of posthepatectomy liver failure (PHLF) in patients with HBV-related hepatocellular carcinoma (HCC). MethodsA retrospective analysis was performed for the patients with HBV-related HCC who underwent hepatectomy in The Affiliated Tumor Hospital of Guangxi Medical University from January 2006 to October 2013. With Child-Pugh score as control, the values of ALBI, APRI, and ALBI combined with APRI in predicting PHLF were analyzed. The chi-square test or the Fisher exact test was used for comparison of categorical data between groups, and the logistic regression model was used to identify independent predictive indices for PHLF. ResultsA total of 1055 patients were enrolled in this study, among whom 151 (14.3%) experienced PHLF. The univariate and multivariate analyses showed that ALBI and APRI were significantly associated with the prognosis of PHLF patients (P<0.001). ALBI and APRI had a significantly higher area under the receiver operating characteristic curve (AUC) than Child-Pugh score (both P<0001). ALBI had a sensitivity of 78.1% and a specificity of 55.8% in predicting PHLF at the optimal cut-off value of -2.77, and the patients with ALBI >-2.77 had a significantly higher incidence rate of PHLF A/B/C than those with ALBI ≤-2.77(P<0.001). APRI had a sensitivity of 61.6% and a specificity of 71.0% in predicting PHLF at the optimal cut-off value of 0.85, and the patients with APRI >0.85 had a significantly higher incidence rate of PHLF A/B/C than those with APRI ≤0.85(P<0.001). The combination of ALBI and APRI had a significantly higher AUC than ALBI or APRI (P<0.001 and P=0.047). The combination of ALBI and APRI had a sensitivity of 78.1% and a specificity of 62.2% in predicting PHLF at the optimal cut-off value of -13.10, and the patients with the combination of ALBI and APRI >-13.10 had a significantly higher incidence rate of PHLF A/B/C than those with the combination of ALBI and APRI ≤-13.10(P<0.001). ConclusionALBI combined with APRI can be used as a new, convenient, and reliable index for predicting PHLF.
【关键字】:癌, 肝细胞; 肝切除术; 肝功能衰竭; 危险因素
【Key words】:carcinoma, hepatocellular; hepatectomy; liver failure; risk factors
【引证本文】:MAI RY, YE JZ, WANG YY, et al. Value of albumin-bilirubin score combined with aspartate aminotransferase-to-platelet ratio index in predicting the development of posthepatectomy liver failure in patients with HBV-related hepatocellular carcinoma[J]. J Clin Hepatol, 2018, 34(2): 292-297. (in Chinese)
麦荣云, 叶甲舟, 王言焱, 等. ALBI联合APRI对HBV相关肝细胞癌肝切除术后肝衰竭发生的预测价值[J]. 临床肝胆病杂志, 2018, 34(2): 292-297.

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