Chen Yi-Fan, Lin Yu-Xin, Chi Miao-Miao, Li Da-Qing, Chen Lin-Tao, Zhang Yu, Wu Rong-Qian, Du Zhao-Qing
Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an 710068, Shaanxi Province, China.
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China.
World J Gastrointest Surg. 2025 Jan 27;17(1):96512. doi: 10.4240/wjgs.v17.i1.96512.
Splenectomy is an effective yet invasive intervention for alleviating portal pressure in patients with hepatitis cirrhosis. However, the current prognostic indicators for predicting long-term overall survival of these patients have several limitations.
To assess the potential of preoperative total bilirubin-albumin (B/A) ratio as a prognostic indicator for patients with hepatitis cirrhosis undergoing splenectomy.
A total of 257 patients diagnosed with hepatitis cirrhosis were retrospectively enrolled in the study. Normality test, -test, Wilcoxon test, test, or Fisher's exact test was employed to analyze the intraoperative and postoperative conditions of the patients. Receiver operating characteristic (ROC) curve analysis was utilized to depict the 10-year overall survival rate.
During the follow-up period, 85.99% of the patients survived, with a median survival time of 64.6 months. Multivariate analysis revealed that total serum B/A ratio was an independent risk factor for overall survival ( = 0.037). ROC curve analysis demonstrated that a B/A ratio of 0.87 was the optimal cut-off value. Consequently, the patients were categorized into two groups: High B/A group ( = 64) and low B/A group ( = 193). The median follow-up time for the high B/A group and low B/A group was 56.8 months and 67.2 months, respectively ( = 0.045). Notably, the high B/A group exhibited a significantly lower 10-year overall survival compared to the low B/A group ( < 0.001). Patients with hepatocellular carcinoma (HCC) had lower overall survival rates. Patients with a high B/A ratio exhibited a lower overall survival than those with a low B/A rate in the overall cohort and the subgroups of patients with HCC or not, early Child-Pugh grade, low albumin-bilirubin grade, and model for end-stage liver disease score ≥ 10 (log-rank test, < 0.001 for all).
The B/A ratio can serve as an effective prognostic indicator for overall survival in patients with hepatitis B virus-related cirrhosis following splenectomy, and a higher B/A ratio may suggest a poorer prognosis.
脾切除术是缓解肝炎肝硬化患者门静脉压力的一种有效但具有侵入性的干预措施。然而，目前用于预测这些患者长期总生存的预后指标存在若干局限性。
评估术前总胆红素与白蛋白（B/A）比值作为肝炎肝硬化患者脾切除术后预后指标的潜力。
本研究回顾性纳入了257例诊断为肝炎肝硬化的患者。采用正态性检验、t检验、Wilcoxon检验、χ²检验或Fisher精确检验分析患者的术中及术后情况。采用受试者工作特征（ROC）曲线分析来描述10年总生存率。
在随访期间，85.99%的患者存活，中位生存时间为64.6个月。多因素分析显示，血清总B/A比值是总生存的独立危险因素（P = 0.037）。ROC曲线分析表明，B/A比值为0.87是最佳截断值。因此，将患者分为两组：高B/A组（n = 64）和低B/A组（n = 193）。高B/A组和低B/A组的中位随访时间分别为56.8个月和67.2个月（P = 0.045）。值得注意的是，高B/A组的10年总生存率显著低于低B/A组（P < 0.001）。肝细胞癌（HCC）患者的总生存率较低。在总体队列以及有或无HCC、早期Child-Pugh分级、低白蛋白-胆红素分级和终末期肝病模型评分≥10的亚组患者中，高B/A比值患者的总生存率低于低B/A比值患者（对数秩检验，所有P < 0.001）。
B/A比值可作为乙肝病毒相关肝硬化患者脾切除术后总生存的有效预后指标，较高的B/A比值可能提示预后较差。
