APRI与5-HT水平对肝切除术后肝衰竭发生的预测价值和影响因素分析

摘要/Abstract

摘要： 目的探讨肝切除术后发生肝功能衰竭的影响因素及天冬氨酸转氨酶/血小板比值(APRI)与外周血5-羟色胺(5-HT)水平对其预测价值。方法选取105例行肝切除术患者的临床资料进行回顾性分析,选取时间为2017年2月至2020年3月,根据术后是否发生肝功能衰竭分为A组(肝功能衰竭,n=21)与B组(未出现肝功能衰竭,n=84),分析影响肝功能衰竭的相关因素,评估APRI、5-HT预测肝切除术后发生肝功能衰竭的AUC值、敏感度、特异度。结果 105例受试者中,经肝切除术治疗后出现肝功能衰竭共21例(20.00%),其中依据肝功能衰竭分级:A级14(66.67%)、B级5(23.81%)、C级2例(9.52%)。21例肝功能衰竭患者中经随访6个月,出现1例死亡(4.76%)。单因素分析显示,A组与B组在性别、体质量、高血压、糖尿病、术前ALT、术前AST、肿瘤数目、肝门阻断时间比较中,差异无统计学意义(P>0.05);而在年龄、肿瘤直径、术前PT、术前白蛋白、术前Child-Pugh分级、手术时间、失血量、肝切除范围比较中,差异具有统计学意义(P>0.05)。二分类Logistic回归分析显示,年龄、肿瘤直径≥10 cm、术前PT、术前白蛋白、术前Child-Pugh分级为C/B级、手术时间、失血量＞1 000 mL、大范围肝切除为影响肝切除术患者术后发生肝功能衰竭的危险因素。A组术前APRI、5-HT高于B组(P<0.05)。ROC曲线分析显示,APRI、5-HT预测肝切除术后发生肝功能衰竭的AUC分别为(0.996、0.853,P<0.05);敏感度分别为100.00%、81.00%,特异度分别为95.20%、84.50%。结论年龄、肿瘤直径、术前PT、术前白蛋白、术前Child-pugh分级、手术时间、失血量、肝切除范围是影响肝切除术后发生肝功能衰竭的危险因素;可通过术前行APRI、5-HT检测,为预测肝功能衰竭的发生提供参考。

关键词: 肝切除术, 肝功能衰竭, 天冬氨酸转氨酶/血小板比值, 5-羟色胺

Abstract: Objective To investigate the influencing factors and the predictive value of aspartate aminotransferase/platelet ratio index (APRI) and 5-hydroxytryptamine (5-HT) levels on post hepatectomy liver failure (PHLF).Methods The clinical data of 105 patients who underwent hepatectomy from February 2017 to March 2020 were retrospectively analyzed. According to occurrence of PHLF, they were divided into group A (liver failure, n=21) and group B (no liver failure, n=84). The influencing factors on liver failure were analyzed. The area under the curve (AUC), sensitivity and specificity of APRI and 5-HT in predicting PHLF were evaluated.Results Among 105 subjects, 21 cases (20.00%) developed PHLF: Grade A 14 (66.67%), Grade B 5 (23.81%), Grade C 2 cases (9.52%) according to the classification of liver failure. Among 21 PHLF patients, 1 patient died (4.76%) during 6 months of following up. Univariate analysis showed that there was no significant difference between 2 groups in gender, weight, hypertension, diabetes, preoperative ALT, preoperative AST, tumor number, and obstructive time of portal vein (P>0.05); There were significant differences of age, tumor diameter, preoperative prothrombin time (PT), preoperative albumin, preoperative Child-Pugh classification, operation time, blood loss, and liver resection range between the 2 groups (P<0.05). Binary logistic regression analysis showed that age, tumor diameter ≥ 10 cm, preoperative PT, preoperative albumin, preoperative Child-Pugh classification as C/B, operation time, blood loss > 1000ml and large-scale hepatectomy were risk factors of PHLF. The preoperative APRI and 5-HT of group A were higher than those of group B (P<0.05). Receiver operator characteristic curve (ROC) analysis showed that the AUC of APRI and 5-HT in predicting PHLF were 0.996 and 0.853 respectively (P<0.05); the sensitivity was 100.00% and 81.00%; the specificity was 95.20% and 84.50%.Conclusion Age, tumor diameter, preoperative PT, preoperative albumin, preoperative Child-Pugh classification, operative time, blood loss and liver resection range are risk factors of PHLF. APRI and 5-HT can be used for preoperative prediction which can provide references on predicting the occurrence of liver failure.

Key words: Hepatectomy, Liver failure, Aspartate aminotransferase/platelet ratio index, 5-hydroxytryptamine

汝国栋, 张纯宣, 王垂芳, 宋来高, 汝琦. APRI与5-HT水平对肝切除术后肝衰竭发生的预测价值和影响因素分析[J]. 肝脏, 2022, 27(4): 426-430.

RU Guo-dong, ZHANG Chun-xuan, WANG Chui-fang, SONG Lai-gao, RU Qi. Predictive value and influence factors of APRI with 5-HT levels on post hepatectomy liver failure[J]. Chinese Hepatolgy, 2022, 27(4): 426-430.

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