使用瞬时弹性成像技术预测乙型肝炎相关肝细胞癌患者肝切除术后肝衰竭

Prediction of posthepatectomy liver failure using transient elastography in patients with hepatitis B related hepatocellular carcinoma.

作者信息

Lei Jie-Wen, Ji Xiao-Yu, Hong Jun-Feng, Li Wan-Bin, Chen Yan, Pan Yan, Guo Jia

机构信息

Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital (EHBH), Second Military Medical University, Shanghai, China.

People's Liberation Army Military Academy, Second Military Medical University, Shanghai, China.

出版信息

BMC Gastroenterol. 2017 Dec 29;17(1):171. doi: 10.1186/s12876-017-0732-4.

BACKGROUND

It is essential to accurately predict Postoperative liver failure (PHLF) which is a life-threatening complication. Liver hardness measurement (LSM) is widely used in non-invasive assessment of liver fibrosis. The aims of this study were to explore the application of preoperative liver stiffness measurements (LSM) by transient elastography in predicting postoperative liver failure (PHLF) in patients with hepatitis B related hepatocellular carcinoma.

METHODS

The study included 247 consecutive patients with hepatitis B related hepatocellular carcinoma who underwent hepatectomy between May 2015 and September 2015. Detailed preoperative examinations including LSM were performed before hepatectomy. The endpoint was the development of PHLF.

RESULTS

All of the patients had chronic hepatitis B defined as the presence of hepatitis B surface antigen (HBsAg) for more than 6 months and 76 (30.8%) had cirrhosis. PHLF occurred in 37 (14.98%) patients. Preoperative LSM (odds ratio, OR, 1.21; 95% confidence interval, 95% CI: 1.13-1.29; P < 0.001) and international normalized ratio (INR) (OR, 1.07; 95% CI: 1.01-1.12; P < 0.05) were revealed to be independent risk factors for PHLF, and a new model was defined as LSM-INR index (LSM-INR index = 0.191LSM + 6.317INR-11.154). The optimal cutoff values of LSM and LSM-INR index for predicting PHLF were 14 kPa (AUC 0.86, 95% CI: 0.811-0.901, P < 0.001) and -1.92 (AUC 0.87, 95% CI: 0.822-0.909, P < 0.001), respectively.

CONCLUSIONS

LSM can be helpful for surgeons to make therapeutic decisions in patients with hepatitis B related hepatocellular carcinoma.

背景

准确预测术后肝衰竭（PHLF）至关重要，这是一种危及生命的并发症。肝脏硬度测量（LSM）广泛用于肝纤维化的无创评估。本研究的目的是探讨术前通过瞬时弹性成像进行肝脏硬度测量（LSM）在预测乙型肝炎相关肝细胞癌患者术后肝衰竭（PHLF）中的应用。

方法

本研究纳入了2015年5月至2015年9月期间连续接受肝切除术的247例乙型肝炎相关肝细胞癌患者。肝切除术前进行了包括LSM在内的详细术前检查。终点是PHLF的发生。

结果

所有患者均患有慢性乙型肝炎，定义为乙肝表面抗原（HBsAg）存在超过6个月，76例（30.8%）患有肝硬化。37例（14.98%）患者发生了PHLF。术前LSM（比值比，OR，1.21；95%置信区间，95%CI：1.13 - 1.29；P < 0.001）和国际标准化比值（INR）（OR，1.07；95%CI：1.01 - 1.12；P < 0.05）被发现是PHLF的独立危险因素，并且定义了一个新模型为LSM - INR指数（LSM - INR指数 = 0.191 * LSM + 6.317 * INR - 11.154）。预测PHLF的LSM和LSM - INR指数的最佳截断值分别为14 kPa（曲线下面积，AUC 0.86，95%CI：0.811 - 0.901，P < 0.001）和 - 1.92（AUC 0.87，95%CI：0.822 - 0.909，P < 0.001）。