【摘要】 目的目前对于肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术后的安全性评估,绝大多数研究都是通过测定残余肝体积(remnant liver volume,RLV)或标准残肝体积(standard remnant liver volume,SRLV)实现,这些研究并没有结合HCC患者肝纤维化严重程度。本研究通过肝纤维化评分指标联合SRLV测定探讨预防不同肝纤维化分期HCC患者术后发生肝功能代偿不全时SRLV的安全临界值。方法收集2014-06-20-2016-08-20广西医科大学附属肿瘤医院行HCC肝切除术的163例患者临床资料,采用ROC曲线分别计算术后病理不同肝纤维化分期和术后肝功能不全者不同肝纤维化分期SRLV的临界值,并进行比较分析;计算4种肝纤维化评分指标天门冬氨酸氨基转移酶与血小板比值指数(aspartate aminotransferase to platelet ratio index,APRI)、Frons指数、FIB4指数(index based on the four factors,FIB4)和S指数对术后病理不同肝纤维化分期进行评分,并比较其评价肝纤维化分期的效能;以评价肝纤维化分期最优指标ROC曲线的Cutoff值进行分组,分别计算不同肝纤维化分期SRLV的临界值。结果术后病理肝纤维化S2~S3和S4期SRLV临界值分别为0.392和0.447L/m2,术后肝功能不全者肝纤维化S2~S3和S4期SRLV临界值分别为0.408和0.451L/m2。FIB4以1.585为临界值,诊断肝纤维化S2~S3期曲线下面积为0.830,优于APRI(z=2.468,P<0.05),与Frons和S指数相比,差异无统计学意义,z值分别为1.120和1.083,均P>0.05;FIB4以2.183为临界值,诊断肝纤维化S4期曲线下面积为0.853,分别优于APRI、Frons和S指数,z值分别为4.612、2.740和2.765,均P<0.05。FIB4以临界值1.585和2.183分别进行分组,评估肝纤维化(S2~S3和S4期)HCC患者术后SRLV临界值,分别为0.421和0.474L/m2。结论 FIB4联合SRLV是评估HCC切除术安全性的最优指标;FIB4≥1.585和SRLV≥0.421L/m2、FIB4≥2.183及SRLV≥0.474L/m2 HCC患者术后发生肝功能不全的概率较小,相对安全。更多还原

【Abstract】 OBJECTIVE At present,most studies evaluate the safety after hepatectomy in hepatocellular carcinoma(HCC)patients by measuring remnant liver volume(RLV)or standard remnant liver volume(SRLV),these studies do not include the severity of liver fibrosis of the patients.This study is to investigate the safety critical values to predict the occurrence of postoperative compensatory hepatic insufficiency in HCC patients with different hepatic fibrosis stages by hepatic fibrosis scoring indexes combined with SRLV.METHODS The clinic data of 163 patients undergoing HCC hepatectomy from June 20,2014 to August 20,2016 in the Affiliated Tumor Hospital of Guangxi Medical University was collected.The ROC curves were adopted to calculate the critic values of SRLV in HCC patients with different stages of hepatic fibrosis after liver resection,and in patients who suffered postoperative compensatory HI for different stages of hepatic fibrosis,then those critic value of SRLV were compared and analyzed respectively,and four hepatic fibrosis scoring indexes were calculated to evaluate their diagnostic performance for hepatic fibrosis stages respectively,according to the corresponding critic values of the optimal hepatic fibrosis scoring index by the ROC curves to predict hepatic fibrosis stages S2-S3,S4,then the patients were divided into two groups to correspondingly calculate the critic values of SRLV respectively.RESULTS The critic values of SRLV in HCC patients with pathological hepatic fibrosis stages S2-S3 and S4 were0.392 and 0.447 L/m2,respectively,however the critic values of SRLV for hepatic fibrosis stages S2-S3 and S4 in patients with postoperative compensatory HI were 0.408 L/m2 and 0.451 L/m2,respectively.When FIB4 was used to predict hepatic fibrosis stage S2-S3 according to the critical value 1.585,the area under the ROC curve was better than that of APRI(z=2.468,P<0.05),but comparing with those of Frons and S indices,no significant difference was found(z=1.120,1.083,P>0.05);when predicting hepatic fibrosis stage S4 with the critical value 2.183,the area under the ROC curve was respectively better than those of APRI,Frons and S index(zvalues were 4.612,2.740 and 2.765,P<0.05),then to predict hepatic fibrosis stage S2-S3 by dividing the patients into two groups with the critical value of 1.585,the critic value of SRLV was 0.421 L/m2 and 0.474 L/m2 to predict hepatic fibrosis stage S4 according to 2.183.CONCLUSION FIB4 combined with SRLV is the best index to evaluate the safety after liver resection in HCC patients,when the preoperative FIB4 is more than 1.585 and SRLV more than 0.421 L/m2,FIB4 more than 2.183 and SRLV more than0.474 L/m2,postoperative compensatory HI less occurs and the patients are relatively safe.更多还原