【摘要】 【目的】天冬氨酸转氨酶-血小板比率指数(APRI)与肝脏纤维化-4指数(FIB-4)等指标已被证实可用于无创性评估肝纤维化、肝硬化程度,对肝细胞癌(HCC)患者肝切除术预后评估有较高的准确性。本研究旨在探讨APRI与FIB-4对HCC患者肝切除术后发生肝功能衰竭(PHLF)的预测能力。【方法】回顾性分析426例在我院接受肝切除术的HCC患者的临床资料。收集患者肝切除术前2周内的实验室数据,计算APRI、FIB-4、Child-Pugh评分。采用受试者工作特征(ROC)曲线确定APRI、FIB-4、Child-Pugh评分的AUC值和最佳临界值。采用单因素和多因素Logistics回归分析确定PHLF的独立危险因素,对比APRI和FIB-4对PHLF的预测能力。【结果】本研究中共有11.3%(48/426)患者发生PHLF。多因素分析显示:大范围肝切除术(≥3个肝段切除)、失血量>400 mL,TBIL、PLT、纤维蛋白原以及APRI、FIB-4均为PHLF的独立危险因素;ROC曲线分析显示:APRI(AUC=0.816)和FIB-4(AUC=0.728)对PHLF的预测能力均优于Child-Pugh评分(AUC=0.566)P均<0.001。【结论】术前APRI与FIB-4都是HCC患者肝切除术后发生PHLF的独立预测因子并有良好的预测价值。更多还原

【Abstract】 【Objective】 The aspartate aminotransferase-to-platelet ratio index(APRI)and liver fibrosis-4 index(FIB-4)have been used for noninvasive prediction of liver fibrosis and cirrhosis and both indexes exhibit a high degree of accuracy in the the prediction of the prognosis of hepatocellular carcinoma(HCC)patients after hepatectomy.. This study aims to explore the predictive values of APRI and FIB-4 in the occurrence of posthepatectomy liver failure(PHLF)in HCC patients.【Methods】The clinical data of 426 patients with HCC who underwent hepatectomy in our hospital were retrospectively analyzed. Laboratory data were collected from patients within 2 weeks prior to hepatectomy. APRI,FIB-4 and Child-Pugh scores were calculated. Receiver operating characteristic(ROC)curves were used to determine the AUC values and optimal cut-off values of APRI,FIB-4 and Child-Pugh scores. Univariate and multivariate logistic regression analyses were employed to identify the independent risk factors for PHLF,and the predictive values of APRI and FIB-4 on PHLF were compared.【Results】A total of 48 patients(11.3%)developed PHLF. Multivariate analysis showed that major hepatectomy（≥3 segments resection）,blood loss >400 mL,total bilirubin(TBIL),platelet(PLT),fibrinogen(Fib),APRI and FIB-4 were independent risk factors for PHLF. ROC curve analysis revealed that APRI(AUC = 0.816)and FIB-4(AUC = 0.728)had better ability to predict PHLF than Child-Pugh score(AUC = 0.566;P<0.001).【Conclusions】Preoperative APRI and FIB-4 are independent predictors of PHLF in HCC patients after hepatectomy and have good predictive values.更多还原