Rahman Sakhawat H, Evans Jessica, Toogood Giles J, Lodge Peter A, Prasad K Rajendra
Royal Free Hospital, Pond Street, London NW3 2QG, England.
Arch Surg. 2008 Mar;143(3):247-53; discussion 253. doi: 10.1001/archsurg.2007.75.
C-reactive protein (CRP) is an acute-phase protein produced by the liver. We hypothesize that an early dampened CRP response after major liver resection is of prognostic importance in predicting posthepatectomy liver failure (PHLF).
Serum CRP levels were determined on postoperative days 1, 3, and 7 in patients undergoing liver resection (stratified into minor [</=2 segments], standard [3 or 4 segments], and extended [>/=5 segments]). Correlations were made with indices of PHLF (hyperbilirubinemia, coagulopathy, ascites, and encephalopathy), multi-organ dysfunction syndrome, sepsis, and death.
Division of Hepatobiliary and Transplant Surgery, Leeds Teaching Hospitals National Health Service Trust, England.
One hundred thirty-eight individuals who underwent liver resection.
Sepsis, PHLF, and mortality.
A total of 138 liver resections (39 minor, 51 standard, and 48 extended) were included. Median serum CRP levels on day 1 were significantly lower after extended liver resection (28 mg/L; range, 5-119 mg/L [to convert to nanomoles per liter, multiply by 9.524]) compared with standard resection (41 mg/L; range, 5-85 mg/L) and minor resection (51 mg/L; range, 8-203 mg/L; chi(2) = 19; P < .001). Similar differences were observed on day 3 (chi(2) = 27; P < .001). Postoperative day 1 CRP levels were significantly lower in patients developing PHLF (hyperbilirubinemia, P = .001; ascites, P < .001; coagulopathy, P = .002; and encephalopathy, P < .001) or multiorgan dysfunction syndrome (P = .009) or who died (P = .01). Day 1 serum CRP levels and extent of resection were independent predictors of PHLF in multivariate analysis.
The early dampened CRP response after major liver resection may reflect poor hepatic reserve that could have prognostic utility.
C反应蛋白（CRP）是肝脏产生的一种急性期蛋白。我们假设，肝大部切除术后早期CRP反应减弱对预测肝切除术后肝功能衰竭（PHLF）具有预后意义。
对接受肝切除术的患者（分为小范围切除[≤2个肝段]、标准范围切除[3或4个肝段]和大范围切除[≥5个肝段]）在术后第1、3和7天测定血清CRP水平。将其与PHLF指标（高胆红素血症、凝血功能障碍、腹水和肝性脑病）、多器官功能障碍综合征、败血症及死亡情况进行相关性分析。
英国利兹教学医院国民保健服务信托基金肝胆与移植外科。
138例行肝切除术的患者。
败血症、PHLF及死亡率。
共纳入138例肝切除术（39例小范围切除、51例标准范围切除和48例大范围切除）。与标准范围切除（41mg/L；范围5 - 85mg/L）和小范围切除（51mg/L；范围8 - 203mg/L；χ² = 19；P < .001）相比，大范围肝切除术后第1天的血清CRP水平中位数显著较低（28mg/L；范围5 - 119mg/L[换算为纳摩尔每升时，乘以9.524]）。在第3天观察到类似差异（χ² = 27；P < .001）。发生PHLF（高胆红素血症，P = .001；腹水，P < .001；凝血功能障碍，P = .002；肝性脑病，P < .001）、多器官功能障碍综合征（P = .009）或死亡（P = .01）的患者术后第1天的CRP水平显著较低。在多因素分析中，第1天的血清CRP水平和切除范围是PHLF的独立预测因素。
肝大部切除术后早期CRP反应减弱可能反映了肝脏储备功能差，具有预后价值。
