剪切波弹性成像评估肝脏硬度预测肝细胞癌患者术后肝功能衰竭。
Liver Stiffness Assessed by Shear Wave Elastography Predicts Postoperative Liver Failure in Patients with Hepatocellular Carcinoma.
机构信息
Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China.
出版信息
J Gastrointest Surg. 2017 Sep;21(9):1471-1479. doi: 10.1007/s11605-017-3443-9. Epub 2017 May 16.
BACKGROUND
Cirrhosis increases a patient's risk of developing postoperative liver failure (PLF). Liver stiffness (LS), assessed by two-dimensional shear wave elastography (SWE), indicates liver fibrosis with high accuracy. Whether LS is superior to portal hypertension (PHT) in predicting PLF remains to be studied.
METHODS
The study enrolled 280 patients who underwent hepatectomy for hepatocellular carcinoma from July 2015 to July 2016. All patients received preoperative assessments for LS, PHT, and serum markers of liver fibrosis in addition to other clinicopathological tests. Risk factors for grade A and grade B (or greater) PLF were subjected to univariate and multivariate analysis and receiver operating characteristic curve analysis.
RESULTS
Fifty-five patients (19.6%) experienced PLF. The cutoff value of LS for predicting cirrhosis was 10.1 kPa. Multivariate analysis identified LS, hyaluronic acid, IV collagen, and the presence of splenomegaly as independent predictors of PLF. The cutoff value of LS for predicting PLF and grade B (or greater) PLF was 11.75 and 11.9 kPa, respectively. LS was superior to PHT in predicting PLF or greater than grade B PLF (0.72 vs. 0.60, 0.76 vs. 0.59, P < 0.05).
CONCLUSION
LS measured by SWE can predict risk of PLF with greater accuracy than PHT.
背景
肝硬化会增加患者术后发生肝功能衰竭（PLF）的风险。通过二维剪切波弹性成像（SWE）评估的肝硬度（LS）能高度准确地反映肝纤维化程度。LS 是否优于门脉高压（PHT）来预测 PLF 仍有待研究。
方法
本研究纳入了 2015 年 7 月至 2016 年 7 月期间因肝细胞癌接受肝切除术的 280 例患者。所有患者除了进行其他临床病理检查外，还接受了 LS、PHT 和血清肝纤维化标志物的术前评估。对 A 级和 B 级（或更高级别）PLF 的危险因素进行单因素和多因素分析及受试者工作特征曲线分析。
结果
55 例患者（19.6%）发生了 PLF。LS 预测肝硬化的截断值为 10.1kPa。多因素分析确定 LS、透明质酸、IV 胶原和脾肿大的存在是 PLF 的独立预测因素。LS 预测 PLF 和 B 级（或更高级别）PLF 的截断值分别为 11.75kPa 和 11.9kPa。LS 在预测 PLF 或大于 B 级 PLF 方面优于 PHT（0.72 比 0.60，0.76 比 0.59，P<0.05）。
结论
通过 SWE 测量的 LS 能比 PHT 更准确地预测 PLF 风险。
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