【摘要】 目的探讨血浆可溶性致癌性抑制基因2(sST2)对肝切除术后肝衰竭(PHLF)的预测价值及其影响因素。方法本前瞻性研究对象为2015年12月至2018年11月在新疆医科大学第一附属医院行肝切除术的141例患者。其中男75例,女66例;年龄33～54岁,中位年龄42岁。原发病:肝细胞癌31例,包虫病74例,肝血管瘤21例,其他疾病15例。患者均签署知情同意书,符合医学伦理学规定。采用ROC曲线确定sST2的最佳诊断界值,分析sST2对PHLF的预测价值。采用Logistic回归模型进行PHLF影响因素分析。结果 sST2的最佳界值为3 676 ng/L,sST2升高组41例,sST2正常组100例。sST2升高组PHLF发生率为85%(35/41),明显高于sST2正常组的14%(14/100)(χ~2=65.31,P<0.05)。术后第1天sST2水平预测PHLF的ROC曲线下面积为0.859,敏感度和特异度分别为0.85、0.87。多因素Logistic回归分析结果显示,大范围切除和术后第1天sST2升高是PHLF发生的独立危险因素(OR=16.476,1.001;P<0.05)。结论血浆sST2水平与PHLF相关,对PHLF发生具有良好的预测价值。更多还原

【Abstract】 Objective To evaluate the predictive value of plasma soluble suppression of tumorigenicity-2 (sST2) on post-hepatectomy liver failure (PHLF) and to explore the influencing factors of PHLF.Methods 141 patients who underwent hepatectomy in the First Affiliated Hospital of Xinjiang Medical University from December 2015 to November 2018 were recruited in this prospective study.Among them,75 cases were male and 66 female,aged from 33 to 54 years,with a median age of 42 years.The primary diseases were hepatocellular carcinoma (n=31),hydatid disease (n=74),hepatic hemangioma (n=21) and other diseases (n=15).The informed consents of all patients were obtained and the local ethical committee approval was received.ROC curve was delineated to determine the optimal diagnostic thresholds of sST2,and the predictive value of sST2 for PHLF was analyzed.The influencing factors of PHLF were identified using Logistic regression model.Results The optimal diagnostic thresholds of sST2 was 3 676 ng/L.41 patients were assigned in the elevated sST2 group and 100 cases in the normal sST2 group.In the elevated sST2 group,the incidence of PHLF was 85%(35/41),significantly higher than 14%(14/100) in the normal sST2 group (χ~2=65.31,P<0.05).The area under ROC curve of sST2 on postoperative 1 d for predicting PHLF was 0.859,the sensitivity was 0.85 and the specificity was 0.87.Multivariate Logistic regression analysis showed that extensive resection and the increase of sST2 on postoperative 1 d were the independent risk factors for PHLF (OR=16.476,1.001;P<0.05).Conclusions The plasma level of sST2 is associated with PHLF,which has high predictive value for PHLF.更多还原