Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China.
Surgery. 2014 Feb;155(2):263-70. doi: 10.1016/j.surg.2013.08.017. Epub 2013 Oct 25.
Total cholesterol (TC) can reflect the degree of liver damage in patients with chronic hepatitis B or C; its role in evaluating liver functional reserve and predicting postoperative complications remains unknown.
The prospectively collected data of 996 consecutive patients with chronic hepatitis B or C undergoing partial hepatectomy for hepatocellular carcinoma in a tertiary institution were retrospectively reviewed. The relationship between preoperative TC and postoperative liver insufficiency, morbidity and mortality were analyzed.
TC showed significant correlation with postoperative complications on receiver operating characteristic curves, with area under the curve of 0.81 (P < .001), 0.79 (P < .001), and 0.85 (P < .001) for postoperative liver insufficiency, morbidity, and mortality, respectively. Using the calculated cutoff at 2.80 mmol/L, Patients with low TC had worse preoperative liver functional reserve and suffered from more postoperative complications when compared with patients with normal TC (≥2.8 mmol/L). Multivariate analysis revealed that low preoperative TC was more powerful in predicting poor postoperative outcomes than Child-Pugh's classification, indocyanine green (ICG) retention test, and Mayo End-Stage Liver Disease (MELD) score. It was an independent risk factor for postoperative morbidity (odds ratio [OR], 4.87; P < .001) and mortality (OR, 14.60; P < .001).
Among patients with chronic virus B or C hepatitis receiving partial hepatectomy, a low TC (<2.8 mmol/L) predicted poor postoperative outcomes. It was better than Child-Pugh's classification, ICG, and MELD score in the prediction of postoperative complications, and was useful in the preoperative evaluation of liver functional reserve.
总胆固醇（TC）可以反映慢性乙型或丙型肝炎患者的肝损伤程度；其在评估肝储备功能和预测术后并发症方面的作用尚不清楚。
回顾性分析了一家三级医院行部分肝切除术治疗肝细胞癌的 996 例连续慢性乙型或丙型肝炎患者的前瞻性采集数据。分析了术前 TC 与术后肝功能不全、发病率和死亡率的关系。
TC 在受试者工作特征曲线中与术后并发症具有显著相关性，其在预测术后肝功能不全、发病率和死亡率方面的曲线下面积分别为 0.81（P<0.001）、0.79（P<0.001）和 0.85（P<0.001）。使用计算出的截断值 2.80mmol/L，与 TC 正常（≥2.8mmol/L）的患者相比，TC 较低的患者术前肝储备功能较差，术后并发症更多。多变量分析表明，与 Child-Pugh 分级、吲哚菁绿（ICG）保留试验和梅奥终末期肝病评分（MELD）相比，术前 TC 水平低更能准确预测术后不良结局。它是术后发病率的独立危险因素（比值比[OR]，4.87；P<0.001）和死亡率（OR，14.60；P<0.001）。
在接受部分肝切除术的慢性病毒 B 或 C 肝炎患者中，低 TC（<2.8mmol/L）预测术后不良结局。它在预测术后并发症方面优于 Child-Pugh 分级、ICG 和 MELD 评分，并且有助于术前评估肝储备功能。
