肝纤维化指标对肝切除术后肝功能不全的预测作用

发布时间：2018-11-17 19:19

【摘要】：背景:术后肝功能不全是肝切除术后最常见的一种并发症,也是围手术期患者死亡的主要原因。临床上运用多种方法在术前对于肝切除术后发生肝功能不全的风险进行预测,包括常规肝功能指标和吲哚氰绿清除试验。肝纤维化相关指标已被证实能够较好的预测术后肝功能不全。方法:本研究最终纳入60例在浙江大学医学院第一附属医院肝胆胰外科行肝切除手术的患者。并对其术后是否发生肝功能不全及相关因素进行回顾性研究,所有患者均接受吲哚氰绿清除试验,并有完整的病例资料及实验室检查。采用卡方检验和独立样本T检验分析相关指标在肝切除术后肝功能不全组和肝功能良好组的差异;采用多因素logistic回归分析在单因素有差异的相关因素并构建预测模型;采用ROC曲线分析各因素对于术后肝功能不全的预测价值。结果:本研究共纳入了 60例肝切除术后患者,其中术后发生肝功能不全的患者21例,未发生肝功能不全的患者39例,卡方检验和独立样本T检验发现在肝切除术后肝功能不全和肝功能良好两组间,吲哚氰绿15分钟滞留率(P=0.024),国际标准化比值(P=0.015),血浆白蛋白(P=0.004),FIB4(P=0.049)和术中失血(P=0.014)五项指标存在显著性差异。对单因素分析中存在差异的四项术前指标进行多因素Logistic 回归分析发现,血浆白蛋白(OR0.851,95%Cl 0.752-0.963),FIB4 指数(OR 1.540,95%Cl 1.030-2.304)是术后肝功能不全的独立风险因素。绘制ROC曲线评价所构建的logistic回归模型,其曲线下面积为(0.811,95%Cl0.689-0.900)。结论:术前FIB4对于肝肿瘤切除术后患者肝功能不全有一定预测价值。基于FIB4和Alb两项因素构建的logistic回归模型可相对有效预测术后肝功能不全的发生。
[Abstract]:Background: postoperative liver insufficiency is the most common complication after hepatectomy and the main cause of perioperative death. A variety of clinical methods were used to predict the risk of liver dysfunction after hepatectomy, including routine liver function indicators and indole green clearance test. Liver fibrosis related indicators have been proved to be a good predictor of postoperative liver dysfunction. Methods: 60 patients underwent hepatectomy in the first affiliated Hospital of Zhejiang University Medical College. A retrospective study was made on the occurrence of liver insufficiency and related factors after operation. All patients were treated with indocyanine green clearance test and had complete case data and laboratory examination. Chi-square test and independent sample T test were used to analyze the difference of correlation indexes between the patients with liver insufficiency and those with good liver function after hepatectomy, and multivariate logistic regression analysis was used to analyze the correlation factors with univariate differences and to build a prediction model. The predictive value of various factors for postoperative liver insufficiency was analyzed by ROC curve. Results: a total of 60 patients after hepatectomy were included in this study, including 21 patients with postoperative hepatic insufficiency and 39 patients with no hepatic insufficiency. Chi-square test and independent sample T test showed that the retention rate of indocyanine green in 15 minutes (P0. 024), the international standard ratio (P0. 015) and the plasma albumin (P0. 004) were found between the two groups after hepatectomy. There were significant differences in five indexes of FIB4 (P0. 049) and intraoperative blood loss (P0. 014). Multivariate Logistic regression analysis showed that plasma albumin (OR0.851,95%Cl 0.752-0.963) was different in univariate analysis. The FIB4 index (OR 1.54095 / Cl 1.030-2.304) was an independent risk factor for postoperative liver dysfunction. The area under the ROC curve was (0.81195Cl 0.689-0.900). Conclusion: preoperative FIB4 is a predictor of liver dysfunction after hepatectomy. The logistic regression model based on FIB4 and Alb can be used to predict postoperative hepatic insufficiency.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

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