摘要
目的 探究纤维化指数(FIB-4)、总胆红素及γ-谷氨酰转肽酶与血小板比值指数(GPRI)水平与肝癌切除术后肝功能衰竭并发症的相关性。方法 回顾性选取2018年3月至2023年3月在长治医学院附属和平医院接受肝癌切除术治疗的肝癌患者,记录患者术后是否并发肝功能衰竭,将发生肝功能衰竭的患者纳入研究组(n=32),并按照1∶2的比例随机抽取64例术后未发生肝功能衰竭的肝癌患者纳入对照组。比较两组患者的一般资料(年龄、性别、体重指数、肿瘤大小、病灶数目、乙肝表面抗原、淋巴结转移情况、术前Child分级、腹水)情况、实验室指标[总胆红素、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、γ-谷氨酰转肽酶(GGT)]水平,计算并对比两组FIB-4、GPRI水平,分析影响患者术后并发肝功能衰竭的因素。结果 两组在平均年龄、年龄段、性别、体重指数、肿瘤大小、病灶数目、乙肝表面抗原、有无淋巴结转移、腹水方面比较差异均无统计学意义(P>0.05),研究组患者术前Child B级占46.88%,高于对照组(17.19%),差异有统计学意义(P<0.05)。研究组FIB-4、总胆红素及GPRI水平分别为2.73±0.35、(18.55±1.04)μmol/L、4.45±0.51,均高于对照组[1.76±0.28、(14.22±1.56)μmol/L、2.11±0.34],差异均有统计学意义(P<0.05)。研究组和对照组患者的LDH水平比较,差异无统计学意义(P>0.05),研究组患者的ALT、AST、GGT水平分别为(39.55±2.45)、(58.98±2.33)、(122.48±12.21) U/L,均高于对照组[(33.23±2.13)、(36.15±2.38)、(76.89±15.49) U/L],差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,FIB-4、总胆红素、GPRI水平均是肝癌患者术后并发肝功能衰竭的危险因素(P<0.05)。经受试者工作特征(ROC)曲线分析,可知FIB-4、总胆红素、GPRI均对患者术后肝功能衰竭存在较高的预测价值,其曲线下面积(AUC)值分别为0.809、0.846、0.839(P<0.05)。结论 FIB-4、总胆红素、GPRI水平均是肝癌患者术后并发肝功能衰竭的危险因素,且FIB-4、总胆红素、GPRI对预测肝癌切除术后并发肝功能衰竭具有一定应用价值。
Objective To explore the correlation between fibrosis index(FIB-4),total bilirubin,and γ-glutamyltranspeptidase to platelet ratio index(GPRI) levels and complications of liver failure after hepatocellular ectomy.Methods Retrospectively selected liver cancer patients who were treated with liver cancer resection at the Heping Hospital Affiliated to Changzhi Medical College from March 2018 to March 2023.Whether patients development liver failure after surgery was recorded,patients with liver failure were included in the study group(n=32) and 64 patients without liver failure were randomly selected into the control group in a ratio of 1∶2.The general information(age,sex,body mass index,tumor size,number of lesions,hepatitis B surface antigen,lymph node metastasis,preoperative child grade,ascites),laboratory indicators [total bilirubin,alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),gamma glutamyl transpeptidase(GGT)] were compared,and the levels of FIB-4 and GPRI in two groups were calculated and compared,as well as the factors affecting postoperative complications of liver failure in patients were analyzed.Results There were no statistically significant differences between the two groups in mean age,age bracket,sex,body mass index,tumor size,number of lesions,hepatitis B surface antigen,lymph node metastasis,ascites(P>0.05).Before surgery,46.88% of patients were classified as Child B grade in the study group,which was higher than that in the control group(17.19%),the difference was statistically significant(P<0.05).The levels of FIB-4,total bilirubin,and GPRI in the study group were 2.73±0.35,(18.55±1.04) μmol/L,and 4.45±0.51,respectively,which were higher than those in the control group [1.76±0.28,(14.22±1.56) μmol/L,and 2.11±0.34],the differences were statistically significant(P<0.05).There was no statistically significant difference in LDH level between the study group and the control group(P> 0.05).The levels of ALT,AST,and GGT in the study group were(39.55±2.45),(58.98±2.33),and(122.48±12.21) U/L,respectively,which were higher than those in the control group[(33.23±2.13),(36.15±2.38),and(76.89±15.49) U/L],the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis showed that FIB-4,total bilirubin,and GPRI levels were risk factors for postoperative liver dysfunction in liver cancer patients(P<0.05).Receiver operating characteristic(ROC) curve analysis showed that FIB-4,total bilirubin,and GPRI had high predictive value for postoperative liver dysfunction in patients,with area under the curve(AUC) values of 0.809,0.846,and 0.839,respectively(P<0.05).Conclusion The levels of FIB-4,total bilirubin and GPRI are related to the occurrence of liver failure complications after hepatocellular carcinoma resection,and FIB-4,total bilirubin and GPRI have certain application value in predicting liver failure after hepatocellular carcinoma resection.
作者
张冬梅
李婷
陈素玲
ZHANG Dong-mei;LI Ting;CHEN Su-ling(Department of Infection,Heping Hospital Affiliated to Changzhi Medical College,Changzhi Shanxi 046000,China)
出处
《临床和实验医学杂志》
2024年第8期830-833,共4页
Journal of Clinical and Experimental Medicine
基金
山西省医学科学研究计划项目(编号:202001981)。
作者简介
通信作者:陈素玲,Email:13835556402@163.com。
