摘要
目的探讨术前血清血管内皮生长因子(VEGF)水平与肝切除术后肝功能衰竭(PHLF)发生风险的相关性。方法采用巢式病例对照研究。将2015年1月至12月间在东方肝胆外科医院行肝切除治疗的肝癌队列中发生PHLF的病人组成病例组,按1∶2的比例在同一队列中匹配未发生PHLF的病人做为对照组。匹配条件为年龄,切除范围,手术时间和术中出血量。通过酶联免疫吸附法检测病例组和对照组术前血清VEGF水平。采用条件logisitic回归分析VEGF对PHLF的影响。结果1243例病人中,107例(8.6%)病人发生PHLF。匹配后共有104例病例组和208例对照组病人纳入分析。结果显示,病例组VEGF水平明显低于对照组(344.6±57.7 vs.422.4±104.0pg/ml,P<0.05)。多因素分析结果显示,术前血清VEGF水平,凝血酶原时间和临床显著性门静脉高压是影响PHLF的危险因素。当VEGF做为二分类变量时,VEGF低水平组(<427 pg/mL)较VEGF高水平组(≥427 pg/mL)PHLF发生风险增大2.41倍。当VEGF做为三分类变量时,VEGF低水平组(<389 pg/mL)较VEGF高水平组(>464 pg/mL)PHLF发生风险增大3.19倍。结论术前血清VEGF水平与PHLF的发生具有明显的相关性,较低水平的血清VEGF会增加PHLF的发生风险。
Objective To investigate the association between the level of preoperative serum VEGF and the riskofpost hepatectomy liver failure(PHLF).Methods Anested case-control study was conducted with a dataset of hepatocellular carcinoma patients who underwent hepatectomy at the Eastern Hepatobiliary Surgery Hospital between January 1,2015 and December 31,2015.Patients with PHLF within one month after hepatectomy were defined as cases,and matched to patients without PHLF based on the age,number of resection segments,operation time and intraoperative bleeding at a 1∶2 ratio.The level of serum VEGF were measured by a human VEGF ELISA.Odds ratios(OR)and 95%confidence intervals(CI)for PHLF according to VEGF level were calculated usingconditional logistic regression model.The stability of serumVEGFconcentration were analysedusing the repeated-measures ANOVA.Results Among 1243 patients who met the inclusion criteria,107(8.6%)patients developed PHLF.After matching,a total of 104 cases and 208 controls were included into analysis.VEGFconcentration was stable regardless of thefreeze–thaw cycles(P>0.05).Serum VEGF level in cases was significantly lower than that in controls(344.6±57.7 vs.422.4±104.0 pg/ml,P<0.05).Multivariate analysis showed that serum VEGF level,prothrombin time and clinically significant portal hypertension were risk factors of developing PHLF.When serum VEGF levels are classified into twocategories based on the median of VEGF level in controls,relative tothe reference group with the high VEGF levels(≥427 pg/mL),thegroup with the low VEGF levels(<427 pg/mL)displayed a 2.41-foldincreased risk of PHLF.As for three categories,compared withthe reference group with the highest VEGF levels(>464 pg/mL),the group with the lowest VEGF concentration(<389 pg/mL)displayed a 3.19-foldincreased risk of PHLF.Conclusion Serum VEGF levels are closely related to the development of PHLF,and lower the VEGF levels,the greater the PHLF risk.
作者
沈皓
陈瑶
夏勇
吴孟超
SHEN Hao;CHEN Yao;XIA Yong;WU Meng-chao(Department of Hepatic SurgeryⅣ,the Eastern Hepatobiliary Surgery Hospital,Second Military Medical University(Navy Military Medical University),Shanghai 200438,China;National Center for Liver Cancer,Second Military Medical University(Navy Military Medical University),Shanghai 200438,China)
出处
《肝胆外科杂志》
2021年第1期20-24,共5页
Journal of Hepatobiliary Surgery
