肝癌肝切除术后ICGR15和PLT对发生肝功能不全预测价值研究

目的肝切除术是肝癌的主要治疗方法之一,肝功能不全是患者术后常见的并发症之一,它容易进一步发展而导致患者死亡,因此术前预测患者肝切除术后发生肝功能不全的风险显得尤为重要。本研究旨在探讨术前吲哚氰绿15min滞留率(indocyanine green retention rate 15min,ICGR15)联合血小板计数(platelet count,PLT)对患者肝切除术后发生肝功能不全的预测意义。方法收集2015-03-01-2017-08-31在广西医科大学附属肿瘤医院行肝切除术的319例巴萨罗那肝癌临床分期(Barcelona Clinic Liver Cancer,BCLC)A期肝细胞癌(hepatocellular carcinoma,HCC)患者的相关资料,患者术前的Child-Pugh分级均为A级。根据患者术后是否发生肝功能不全将其分为肝功能不全组80例与未发生肝功能不全组239例,并比较2组患者的临床资料。计量资料采用t检验,计数资料采用χ^2检验或Fisher精确试验;利用二元Logistic回归分析术后患者发生肝功能不全的独立影响因素并构建预测模型;使用受试者工作特征曲线(receiver operating characteristic curve,ROC)计算各指标预测患者术后肝功能不全的价值。结果在单因素分析中,对2组患者的PLT、总胆红素(total bilirubin,TB)、白蛋白(albumin,ALB)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、凝血酶原时间(prothrombin time,PT)、ICGR15、肝硬化和腹水分别对应进行比较,差异均有统计学意义,P<0.05。二元Logistic回归分析结果表明,ICGR15分层、PLT分层、PT分层、AST分层及腹水是患者术后发生肝功能不全的独立危险因素。将ICGR15和PLT纳入Logistic回归模型,建立ICGR15PLT预测模型,方程为Logit(P)=0.133×ICGR15-0.008×PLT-0.237。ICGR15PLT模型、ICGR15和PLT预测患者术后肝功能不全的ROC下面积分别为0.732、0.702和0.689。结论在预测HCC患者术后发生肝功能不全方面,单独应用ICGR15或PLT有一定的预测意义,而ICGR15联合PLT则预测意义更大。

Predictive significance of indocyanine green 15-minute retention rate combined with platelet count in patients with hepatic insufficiency after hepatectomy

OBJECTIVE Hepatectomy is one of the main treatments for liver cancer.Liver dysfunction is one of the common complications after surgery,which can lead to death.Therefore,it is particularly important to predict the risk of liver dysfunction after hepatectomy in patients before surgery.The aim of this study was to investigate the predictive value of preoperative guanidine green 15 minute retention rate(ICGR15)combined with platelet count(PLT)for hepatic insufficiency after hepatectomy.METHODS Totally 319 cases of liver cancer resection in the Cancer Hospital of Guangxi Medical University were collected from 2015-03-01-2017-08-31,who were all the hepatocellular carcinoma(HCC)patient with clinical stage of Barcelona Clinic Liver Cancer(BCLC)A and preoperative Child-Pugh grade A.According to whether the patient had liver dysfunction after surgery,they divided into liver dysfunction group of 80 cases and no liver dysfunction group of 239 cases,and the clinical data of the two groups was compared.The t-test was used for the measurement data,and the chi-square test was used for the count data.The independent influence factors of hepatic insufficiency in the postoperative patients were analyzed by binary logistic regression and the prediction model was constructed.The receiver operating characteristic curve(ROC)was used.Calculate the value of each indicator to predict postoperative liver dysfunction in patients.RESULTS In the univariate analysis,PLT,total bilirubin(TB),albumin(ALB),aspartate aminotransferase(AST),and Alanine aminotransferase(ALT)were used in the two groups of patients.Prothrombin time(PT),ICGR15,cirrhosis and ascites were compared,and the differences were statistically significant(P<0.05).Binary logistic regression analysis showed that ICGR15 stratification,PLT stratification,PT stratification,AST stratification and ascites were independent risk factors for postoperative hepatic insufficiency in patients.The ICGR15 and PLT were included in the logistic regression model,and the ICGR15 PLT prediction model was established.The equation was Logit(P)=0.133×ICGR15-0.008×PLT-0.237.The ICGR15 PLT model,ICGR15 and PLT predicted the area under the ROC postoperative liver dysfunction in patients was 0.732,0.702 and 0.689,respectively.CONCLUSION The use of ICGR15 or PLT alone to predict postoperative hepatic insufficiency in patients with hepatectomy has a certain significance,and ICGR15 combined with PLT has a greater predictive value for hepatic insufficiency after hepatectomy than ICGR15 or PLT alone.