摘要
背景与目的:肝纤维化的严重程度与肝切除术后并发症的发生率密切相关,全面且准确地对患者的肝纤维化程度进行术前评估对于手术方式的选择及患者的预后至关重要。本研究试图探索能否通过某些检查指标亦或是由这些指标所构建的预测模型来准确且全面地预测患者肝纤维化的严重程度。方法:选择2018年9月—2019年12月期间共计106例行肝切除术治疗患者的临床数据进行回顾性分析,并根据术后病理切片的肝纤维化等级(Laennec分期系统)分为无或低级别肝纤维化组(50例)和高级别肝纤维化组(56例)。先将两组患者的检查指标全部进行单因素分析,选出其中有统计学差异的指标纳入多因素Logistic回归分析,筛选出独立预测指标并建立综合预测模型。最后建立受试者工作特征(ROC)曲线,评价独立预测指标及综合预测模型的预测效果。结果:单因素分析结果显示,两组之间白细胞(WBC)、血小板(PLT)、凝血酶原时间(PT)、血肌酐(Cr)、吲哚氰绿15分钟滞留率(ICG15)、门静脉宽度及门静脉流速的差异具有统计学意义(均P<0.05)。多因素回归分析结果显示,ICG15与门静脉宽度为高级别肝纤维化的独立预测指标(均P<0.05),以此建立综合预测模型为Logit(P)=-6.026+0.44×ICG15+0.299×门静脉宽度。该综合模型预测高级别肝纤维化的ROC曲线的AUC为0.88,截断值为0.359时,敏感度为89.3%,特异度为74%。该模型的预测效果优于两个独立预测指标。结论:ICG15与门静脉宽度是肝纤维化的严重程度独立评价指标,联合ICG15与门静脉宽度的综合预测模型能对患者肝纤维化严重程度进行更为准确的术前评估,具有一定的临床参考价值。
Background and Aims:The severity of liver fibrosis is closely related to the incidence of complications after hepatectomy.Thus,a comprehensive and accurate preoperative assessment of the patient’s liver fibrosis is of great importance for surgical procedure selection and prognosis of patients.Thus,this study was aimed to explore whether certain indicators or a prediction model constructed from these indicators can accurately and comprehensively predict the severity of liver fibrosis in patients.Methods:The clinical data of 106 patients who underwent hepatectomy from September 2018 to December 2019 were collected for retrospective analysis,and those patients were divided into none/low-stage fibrosis group(50 patients)and high-stage fibrosis group(56 patients)based on the histological classification of liver fibrosis(Laennec staging system).Firstly,all the tested indexes of the two groups of patients were assessed by univariate analysis,and then those with significant differences were included in the multivariate regression analysis to screen out the independent prediction indicators and establish an integrated prediction model.Finally,the receiver operating characteristic(ROC)curve was established to evaluate the predictive efficacy of the independent predictive indicators and the integrated prediction model.Results:Results of univariate analysis showed that there were significant differences between the two groups in terms of white blood cell(WBC),platelet(PLT),prothrombin time(PT),creatine(Cr),indocyanine green retention rate at 15 minutes(ICG15),width of portal vein and velocity of portal blood flow(all P<0.05).Results of multivariate regression analysis revealed that ICG15 and the width of portal vein were independent predictors for high-stage liver fibrosis(both P<0.05),and the established integrated predictive model based on the two variables was Logit(P)=–6.026+0.44×ICG15+0.299×width of portal vein.Moreover,the area under ROC curve(AUC)of the integrated predictive model was 0.88,with a sensitivity of 89.3%and a specificity of 74%at the cutoff value of 0.359.The predictive efficacy of the integrated prediction model was superior to either prediction indicator alone.Conclusion:ICG15 and the width of portal vein are independent evaluation indicators for the severity of liver fibrosis,and the integrated prediction model combined with ICG15 and portal vein width offers more accurate preoperative assessment of the severity of liver fibrosis in patients,which has certain clinical reference value.
作者
李哲成
黄云
张泽宇
李娟妮
胡宽
王志明
LI Zhecheng;HUANG Yun;ZHANG Zeyu;LI Juanni;HU Kuan;WANG Zhiming(Department of Hepatic Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Pathology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2020年第11期1364-1369,共6页
China Journal of General Surgery
关键词
肝切除术
肝硬化
比例危险度模型
Hepatectomy
Liver Cirrhosis
Proportional Hazards Models
