Zheng Jun, Xing Rong-Chun, Zheng Wei-Hong, Liu Wei, Yao Ru-Cheng, Li Xiao-Song, Du Jian-Ping, Li Lin
Institute of Hepatopancreatobiliary Surgery, Department of General Surgery, the First College of Clinical Medical Science, China Three Gorges University, Yichang 443002, China.
J BUON. 2017 May-Jun;22(3):709-713.
In our previous study, we have established the clinical significance of the SFLI (scoring formula of liver injury), the purpose of this study was to compare the SFLI system and the Child-Pugh grading system in the prediction of postoperative mortality in patients with hepatocellular carcinoma (HCC).
114 patients with HCC who underwent surgical treatment were enrolled. According to the requirement of the indicators for the Child-Pugh classification, various indices (including albumin [ALB], total bilirubin [TBIL], prothrombin time [PT], ascites, and hepatic encephalopathy) were considered in these patients before surgery, and then Child-Pugh grading was performed. Similarly, the serum biochemical markers including ALB, pre-albumin (PA), TBIL, serum creatining (SCR), international normalized ratio (INR), alanine transminase (ALT), aspartate transaminase (AST), γ-glutamyl transpeptidase (ggr;-GT), alkaline phosphatase (ALP), PT, activated partial thromboplastin time (APTT), and thrombine time (TT) were collected before surgery for SFLI analysis. The predicted postoperative mortality rates of these two scoring models and their diagnostic efficacy were analyzed and compared.
According to the Child-Pugh grading system, in level A, B and C were 75, 35, and 4 cases respectively, and the corresponding mortality rates were 1.3% (1/75), 17.1% (6/35) and 75% (3/4). Meanwhile, according to the SLFI classification, the number of patients in the grade I, I+, II, and III were 36, 29, 28, and 21, respectively, and the corresponding mortality rates were 0, 0, 14.3% (4/28), and 28.6% (6/21), respectively. The patient mortality rate increased significantly with increasing grading (p<0.01). These two classification methods were further compared using ROC analysis, in which the area under the curve (AUC) for the Child-Pugh method was 10.2% with a 95% confidence interval (95% CI) 17-18, and the AUC of SFLI was 88.2% with a 95% CI 80-96.
The SFLI scoring system is very useful in the assessment of liver function and postoperative mortality, and its grading standard is much better than the traditional Child-Pugh classification in many aspects.
在我们之前的研究中，我们已经确立了肝损伤评分公式（SFLI）的临床意义，本研究的目的是比较SFLI系统和Child-Pugh分级系统在预测肝细胞癌（HCC）患者术后死亡率方面的效果。
纳入114例行手术治疗的HCC患者。根据Child-Pugh分类指标的要求，在这些患者术前考虑各项指标（包括白蛋白[ALB]、总胆红素[TBIL]、凝血酶原时间[PT]、腹水和肝性脑病），然后进行Child-Pugh分级。同样，术前收集血清生化标志物包括ALB、前白蛋白（PA）、TBIL、血清肌酐（SCR）、国际标准化比值（INR）、谷丙转氨酶（ALT）、谷草转氨酶（AST）、γ-谷氨酰转肽酶（γ-GT）、碱性磷酸酶（ALP）、PT、活化部分凝血活酶时间（APTT）和凝血酶时间（TT）用于SFLI分析。分析并比较这两种评分模型的预测术后死亡率及其诊断效能。
根据Child-Pugh分级系统，A级、B级和C级分别有75例、35例和4例，相应的死亡率分别为1.3%（1/75）、17.1%（6/35）和75%（3/4）。同时，根据SFLI分类，I级、I+级、II级和III级的患者数量分别为36例、29例、28例和21例，相应的死亡率分别为0、0、14.3%（4/28）和28.6%（6/21）。患者死亡率随分级增加而显著升高（p<0.01）。使用ROC分析进一步比较这两种分类方法，其中Child-Pugh方法的曲线下面积（AUC）为10.2%，95%置信区间（95%CI）为17 - 18，SFLI的AUC为88.2%，95%CI为80 - 96。
SFLI评分系统在评估肝功能和术后死亡率方面非常有用，其分级标准在许多方面优于传统的Child-Pugh分类。
