ALBI、EZ-ALBI及PALBI评分对HCV相关肝细胞癌患者中期预后的预测价值分析

木唤; 张映媛; 许丹青; 何愿强; 牟春燕; 刘春云; 刘立

doi:10.12449/JCH250518

ALBI、EZ-ALBI及PALBI评分对HCV相关肝细胞癌患者中期预后的预测价值分析

DOI: 10.12449/JCH250518

昆明市第三人民医院（云南省传染性疾病临床医学中心）肝病免疫科，昆明 650041

基金项目:

佑安专科联盟科研专项基金 (LM202014)

伦理学声明：本研究方案于2024年1月30日经由昆明市第三人民医院伦理委员会审批，批号：KSLL20240130004。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：木唤负责设计论文框架，起草论文；张映媛、许丹青负责收集相关数据和文献；何愿强、牟春燕负责统计学分析，绘制图表；刘春云、刘立负责修改论文。

详细信息

通信作者:
刘立， liuli197210@163.com （ORCID： 0000-0001-7712-4931）

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出版历程
- 收稿日期: 2024-09-20
- 录用日期: 2024-11-22
- 出版日期: 2025-05-25

Value of albumin-bilirubin， easy albumin-bilirubin， and platelet-albumin-bilirubin scores in predicting the prognosis of patients with HCV-associated hepatocellular carcinoma

Department of Immunopathy and Hepatology，Yunnan Provincial Clinical Medical Center for Infectious Diseases，The Third People’s Hospital of Kunming，Kunming 650041，China

Research funding:

Research Special Fund of YouAn Vocational Alliance (LM202014)

More Information

Corresponding author: LIU Li， liuli197210@163.com （ORCID： 0000-0001-7712-4931）

摘要

摘要: 目的探讨白蛋白-胆红素（ALBI）、简易白蛋白-胆红素（EZ-ALBI）及血小板-白蛋白-胆红素（PALBI）评分对HCV相关肝细胞癌（HCV-HCC）患者2年生存期的预测价值。方法回顾性分析2020年1月—2022年1月于昆明市第三人民医院住院治疗的174例HCV-HCC患者临床资料，随访时间为入院后2年。根据随访结果将患者分为生存组（n=95）和死亡组（n=79）。计量资料两组间比较采用成组t检验或Mann-Whitney U检验。计数资料两组间比较采用χ²检验。采用单因素和多因素Cox比例风险回归模型分析HCV-HCC患者生存的影响因素。通过Kaplan-Meier法绘制生存曲线，分析不同EZ-ALBI分级HCV-HCC患者的2年生存率，并使用Log-rank检验进行组间比较。结果生存组与死亡组患者比较，PLT、AST、TBil、Alb、AFP、前白蛋白、凝血酶原时间、国际标准化比值、PALBI评分、ALBI评分、EZ-ALBI评分、终末期肝病模型（MELD）评分、HCV基因分型、腹腔积液、血管侵犯差异均有统计学意义（P值均<0.05）。单因素Cox回归分析结果显示，AST、Alb、AFP、ALBI评分、EZ-ALBI评分、PALBI评分、MELD评分、巴塞罗那临床肝癌分期和腹腔积液是患者生存的影响因素（P值均<0.05）；进一步多因素Cox回归分析结果显示，EZ-ALBI评分（HR=1.850，95%CI：1.054～3.247，P=0.032）和腹腔积液（HR=1.993，95%CI：1.030～3.858，P=0.041）是HCV-HCC患者生存的独立危险因素。生存曲线分析结果显示，EZ-ALBI 1级、2级、3级患者的2年生存率分别为90.9%、60.2%和32.2%，不同EZ-ALBI分级患者累积生存率比较，差异有统计学意义（χ²=26.294，P<0.001）。结论 EZ-ALBI评分及有无腹腔积液可作为HCV-HCC患者生存情况的预测指标。
- 肝炎病毒属 /
- 癌，肝细胞 /
- ALBI评分 /
- EZ-ALBI评分 /
- PALBI评分 /
- 预后
Abstract: Objective To investigate the value of albumin-bilirubin （ALBI）， easy albumin-bilirubin （EZ-ALBI）， and platelet-albumin-bilirubin （PALBI） scores in predicting 2-year survival in patients with HCV-associated hepatocellular carcinoma （HCV-HCC）. Methods A retrospective analysis was performed for the clinical data of 174 patients with HCV-HCC who were admitted to The Third People’s Hospital of Kunming from January 2020 to January 2022， and the patients were followed up till 2 years after admission. According to the follow-up results， the patients were divided into survival group with 95 patients and death group with 79 patients. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the survival of HCV-HCC patients. The Kaplan-Meier method was used to plot survival curves and analyze the 2-year survival rate of HCV-HCC patients with different EZ-ALBI grades， and the log-rank test was used for comparison between groups. Results There were significant differences between the survival group and the death group in platelet count， aspartate aminotransferase （AST）， total bilirubin， albumin （Alb）， alpha-fetoprotein （AFP）， prealbumin， prothrombin time， international normalized ratio， PALBI score， ALBI score， EZ-ALBI score， Model for End-Stage Liver Disease （MELD） score， HCV genotype， peritoneal effusion， and vascular invasion （all P<0.05）. The univariate Cox regression analysis showed that AST， Alb， AFP， ALBI score， EZ-ALBI score， PALBI score， MELD score， Barcelona Clinic Liver Cancer Staging， and peritoneal effusion were influencing factors for the survival of patients （all P<0.05）， and the multivariate Cox regression analysis showed that EZ-ALBI score （hazard ratio ［HR］=1.850， 95% confidence interval ［CI］： 1.054 — 3.247， P=0.032） and peritoneal effusion （HR=1.993， 95%CI： 1.030 — 3.858， P=0.041） were independent risk factors for the survival of HCV-HCC patients. The survival curve analysis showed that the patients with EZ-ALBI grade 1/2/3 had a 2-year survival rate of 90.9%， 60.2%， and 32.2%， respectively， and there was a significant difference in cumulative survival rate between the patients with different EZ-ALBI grades （χ²=26.294， P<0.001）. Conclusion EZ-ALBI score and the presence or absence of peritoneal effusion can be used as predictors of the survival of HCV-HCC patients.
- Hepacivirus /
- Carcinoma， Hepatocellular /
- ALBI Score /
- EZ-ALBI Score /
- PALBI Score /
- Prognosis

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图 1 不同EZ-ALBI分级患者的生存曲线

Figure 1. Survival function curve of EZ-ALBI grading

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表 1 两组患者基本资料

Table 1. Basic information of two groups of patients

项目	生存组（n=95）	死亡组（n=79）	统计值	P值
男/女（例）	76/19	58/21	χ²=1.056	0.304
年龄（岁）	55.13±8.57	54.19±6.37	t=-0.804	0.423
血管侵犯（有/无，例）	41/54	52/27	χ²=8.905	0.003
HCV基因分型（3型/其他，例）	52/43	55/24	χ²=4.035	0.045
腹腔积液（有/无，例）	58/37	68/11	χ²=13.520	<0.001
BCLC分期（例）			χ²=9.001	0.061
0期	17	4
A期	20	19
B期	37	28
C期	6	7
D期	15	21
PLT（×10⁹/L）	90（68～131）	102（59～153）	Z=-0.846	<0.001
ALT（U/L）	34（20～67）	36（28～85）	Z=-1.291	0.197
AST（U/L）	50（35～100）	86（48～148）	Z=-3.278	0.001
PT（s）	15.4（14.5～17.1）	16.7（15.6～18.2）	Z=-3.691	<0.001
TBil（μmol/L）	23.5（17.4～42.8）	41.8（23.3～93.9）	Z=-3.651	<0.001
PAB（mg/L）	100.00（61.40～141.05）	71.45（49.45～107.05）	Z=-3.498	<0.001
Alb（g/L）	33.13±6.75	28.79±5.39	t=4.723	<0.001
GGT（U/L）	112.30（42.25～279.25）	132.35（65.00～275.25）	Z=-1.063	0.288
AFP（log₁₀ng/mL）	1.56（0.84～3.36）	2.88（1.33～4.19）	Z=-2.595	0.009
CREA（μmol/L）	63.00（49.25～77.25）	76.72（65.00～83.00）	Z=-0.642	0.521
INR	1.36（1.16～1.43）	1.43（1.26～1.52）	Z=-2.977	0.003
HCV RNA（有/无，例）	32/63	36/43	χ²=2.559	0.110
PALBI评分（分）	-2.109（-2.502～-1.822）	-1.714（-2.054～-1.317）	Z=-4.944	<0.001
ALBI评分（分）	-2.58（-3.14～-2.17）	-2.16（-2.53～-1.88）	Z=-4.578	<0.001
EZ-ALBI评分（分）	-27.85（-33.54～-22.68）	-22.17（-27.02～-17.51）	Z=-4.959	<0.001
MELD评分（分）	12.55（9.02～13.72）	15.05（10.98～17.69）	Z=-3.677	<0.001
饮酒史（有/无，例）	67/28	52/27	χ²=0.441	0.506
吸毒史（有/无，例）	46/49	38/41	χ²=0.002	0.966
手术方式（例）			χ²=2.157	0.324
介入	77	57
外科	3	5
未处理	15	17
注：BCLC分期，巴塞罗那临床肝癌分期；PT，凝血酶原时间；PAB，前白蛋白；CREA，肌酐；INR，国际标准化比值。

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表 2 单因素Cox比例风险回归分析HCV-HCC患者生存的影响因素

Table 2. Single factor Cox proportional hazards regression analysis of factors affecting survival in HCV-HCC patients

项目	HR	95%CI	P值
性别（男 vs 女）	1.284	0.779～2.116	0.326
年龄（岁）	0.989	0.961～1.018	0.448
PLT（×10⁹/L）	1.002	1.000～1.005	0.080
ALT（U/L）	1.001	0.999～1.003	0.323
AST（>40 U/L vs ≤40 U/L）	2.017	1.149～3.541	0.015
PT（s）	1.029	0.981～1.078	0.240
Alb（>34 g/L vs ≤34 g/L）	0.925	0.982～0.960	<0.001
AFP（log₁₀ng/mL）	1.226	1.060～1.418	0.006
ALBI评分（分）	2.181	1.401～3.397	0.001
EZ-ALBI评分（分）	2.496	1.708～3.646	<0.001
PALBI评分（分）	2.908	1.886～4.482	<0.001
基因分型（3型 vs 其他）	1.613	0.998～2.608	0.051
血管侵犯（有 vs 无）	1.538	0.986～2.398	0.057
BCLC分期（0期 vs A期 vs B期 vs C期 vs D期）	1.199	1.009～1.426	0.039
手术方式（介入 vs 外科 vs 未处理）	1.168	0.898～1.519	0.247
MELD评分（分）	1.463	1.125～1.902	0.005
腹腔积液（有 vs 无）	2.819	1.490～5.333	0.001

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