作为日本肝脏学会肝癌循证临床实践指南一部分的白蛋白-胆红素（ALBI）分级：与肝损伤及Child-Pugh分级的比较
Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications.
作者信息
Hiraoka Atsushi, Kumada Takashi, Kudo Masatoshi, Hirooka Masashi, Tsuji Kunihiko, Itobayashi Ei, Kariyama Kazuya, Ishikawa Toru, Tajiri Kazuto, Ochi Hironori, Tada Toshifumi, Toyoda Hidenori, Nouso Kazuhiro, Joko Kouji, Kawasaki Hideki, Hiasa Yoichi, Michitaka Kojiro
机构信息
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Gifu, Japan.
出版信息
Liver Cancer. 2017 Jun;6(3):204-215. doi: 10.1159/000452846. Epub 2017 Mar 9.
AIM/BACKGROUND: The purpose of this study was to evaluate the validity of 3 classifications for assessing liver function, the liver damage and Child-Pugh classifications and the newly proposed albumin-bilirubin (ALBI) grade, in order to examine the feasibility of evaluating hepatic function using ALBI grade with the hepatocellular carcinoma (HCC) treatment algorithm used in Japan.
METHODS
We analyzed the medical records of 3,495 Japanese HCC patients admitted from 2000 to 2015, which were comprised of 1,580 patients hospitalized in the Ehime Prefecture area and used as a training cohort (Ehime group), and 1,915 others who were used for validation (validation group). ALBI score used for grading (≤-2.60 = grade 1, greater than -2.60 to ≤-1.39 = grade 2, greater than -1.39 = grade 3) as well as clinical features and prognosis (Japan Integrated Staging [JIS], modified JIS, ALBI-TNM [ALBI-T] score) were retrospectively investigated.
RESULTS
For prediction of liver damage A, the values for sensitivity and specificity, positive predictive and negative predictive values, and positive and negative likelihood ratios of ALBI-1 and Child-Pugh A were similar among the 2 groups. Akaike information criterion results showed that prognosis based on ALBI grade/ALBI-T score was better than that based on liver damage/modified JIS score and Child-Pugh/JIS score (22,291.8/21,989.4, 22,379.6/22,076.0, 22,392.1/22,075.1, respectively). The cutoff values for ALBI score for indocyanine green retention rate at 15 min (ICG-R15) <10, <20, and <30% were -2.623 (area under the curve [AUC]: 0.798), -2.470 (AUC: 0.791), and -2.222 (AUC: 0.843), respectively. The distribution of ICG-R15 (<10%, 10 to <20%, 20 to <30%, and ≥30%) for ALBI grade 1 was similar to that for liver damage A. There were only small differences with regard to therapeutic selection with the Japanese HCC treatment algorithm between liver damage and ALBI grade.
CONCLUSION
ALBI grade is a useful and easy classification system for assessment of hepatic function for therapeutic decision making.
目的/背景：本研究旨在评估三种用于评估肝功能的分类方法（肝损伤分类、Child-Pugh分类以及新提出的白蛋白-胆红素（ALBI）分级）的有效性，以检验在日本肝细胞癌（HCC）治疗方案中使用ALBI分级评估肝功能的可行性。
方法
我们分析了2000年至2015年收治的3495例日本HCC患者的病历，其中包括在爱媛县地区住院的1580例患者作为训练队列（爱媛组），以及另外1915例用于验证的患者（验证组）。回顾性调查了用于分级的ALBI评分（≤ -2.60 = 1级，大于 -2.60至≤ -1.39 = 2级，大于 -1.39 = 3级）以及临床特征和预后（日本综合分期[JIS]、改良JIS、ALBI-TNM[ALBI-T]评分）。
结果
对于肝损伤A的预测，ALBI-1和Child-Pugh A在两组中的敏感性、特异性、阳性预测值和阴性预测值以及阳性和阴性似然比的值相似。赤池信息准则结果显示，基于ALBI分级/ALBI-T评分的预后优于基于肝损伤/改良JIS评分和Child-Pugh/JIS评分的预后（分别为22291.8/21989.4、22379.6/22076.0、22392.1/22075.1）。15分钟吲哚菁绿滞留率（ICG-R15）<10%、<20%和<30%时ALBI评分的截断值分别为-2.623（曲线下面积[AUC]：0.798）、-2.470（AUC：0.791）和-2.222（AUC：0.843）。ALBI 1级的ICG-R15（<10%、10%至<20%、20%至<30%和≥30%）分布与肝损伤A的分布相似。在日本HCC治疗方案中，肝损伤和ALBI分级在治疗选择方面仅有微小差异。
结论
ALBI分级是一种用于评估肝功能以进行治疗决策的有用且简便的分类系统。
Zotero 插件