基于二维剪切波弹性成像预测原发性肝细胞癌切除术后肝衰竭的价值

周涛; 孙志超; 陈继文; 王晓涛; 陈刚; 李新苗

doi:10.16766/j.cnki.issn.1674-4152.003028

基于二维剪切波弹性成像预测原发性肝细胞癌切除术后肝衰竭的价值

doi: 10.16766/j.cnki.issn.1674-4152.003028

1.
浙江省荣军医院放射介入科，浙江嘉兴 314000
2.
浙江省中医院放射科，浙江杭州 310006
3.
浙江省荣军医院超声科

基金项目:

浙江省中医药科技计划项目 2020ZB091

详细信息

通讯作者:
孙志超，E-mail：szcdoctor@163.com

中图分类号: R735.7 R730.6
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出版历程
- 收稿日期: 2022-12-23
- 网络出版日期: 2023-08-26

Value of predicting liver failure after primary hepatocellular carcinoma resection based on two-dimensional shear wave elastography

1.
Department of Radiological Interventions, Zhejiang Veterans Hospital, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的探讨二维剪切波弹性成像(2D-SWE)预测原发性肝细胞癌切除术后肝衰竭的价值，帮助医师判断预后。方法回顾性分析2021年5月—2022年5月在浙江省荣军医院及浙江省中医院行原发性肝细胞癌切除术的180例患者的临床资料，根据术后是否发生肝衰竭分为肝衰竭组(35例)和非肝衰竭组(145例)。患者术前接受实验室和2D-SWE检查，经单因素分析和多因素logistic回归分析筛选出预测原发性肝细胞癌切除术后肝衰竭的危险因素，并分析其预测价值。结果单因素分析结果显示，肝衰竭组和非肝衰竭组在白蛋白、总胆红素、谷草转氨酶、γ-谷氨酰转移酶、凝血酶原时间、国际标准化比值及Child-Pugh评分、终末期肝病模型(MELD)评分、肿瘤大小、有肝门阻断、肝脏硬度值的差异有统计学意义(均P < 0.05)。经多因素logistic回归分析，国际标准化比值、肿瘤大小、肝脏硬度值是原发性肝细胞癌切除术后肝衰竭的独立影响因素(OR=5.078、4.943、5.073，均P < 0.05)。经ROC曲线分析，国际标准化比值、肿瘤大小、肝脏硬度值预测原发性肝细胞癌切除术后肝衰竭的曲线下面积为0.791、0.829、0.994，预测效能较好。结论基于2D-SWE预测原发性肝细胞癌切除术后肝衰竭的临床价值较高，国际标准化比值在1.01及以上、肿瘤大小在4.82 cm及以上、肝脏硬度值在10.66 kPa及以上是原发性肝细胞癌切除术后肝衰竭的独立危险因素。
- 原发性肝细胞癌 /
- 切除术 /
- 肝衰竭 /
- 二维剪切波弹性成像
Abstract: Objective To explore the value of two-dimensional shear wave elastography (2D-SWE) in predicting liver failure after resection of primary hepatocellular carcinoma (HCC) and to help doctors judge the prognosis. Methods The clinical data of 180 patients who underwent primary hepatocellular carcinoma resection in Zhejiang Provincial Veterans ' Hospital and Zhejiang Provincial Hospital of Traditional Chinese Medicine from May 2021 to May 2022 were analyzed retrospectively. They were divided into liver failure group (35 cases) and non-liver failure group (145 cases) according to whether there was liver failure after surgery. The patients received laboratory and 2D-SWE examination before operation. Through univariate analysis and multivariate logistic regression analysis, the risk factors for predicting liver failure after primary hepatocellular carcinoma resection were screened, and their predictive value was analyzed. Results Univariate analysis showed that there were significant differences in albumin, total bilirubin, aspartate aminotransferase, γ-glutamyltransferase, prothrombin time, international standardized ratio and Child Pugh score, model for end-stage liver disease (MELD) score, tumor size, hepatic portal occlusion, and liver hardness (all P < 0.05). Multivariate logistic regression analysis showed that international standardized ratio, tumor size and liver hardness were independent risk factors for liver failure after resection of primary hepatocellular carcinoma (OR=5.078, 4.943, 5.073, all P < 0.05). The ROC curve analysis results showed that the area under the curve for predicting liver failure after primary hepatocellular carcinoma resection using international standardized ratios, tumor size, and liver hardness values were 0.791, 0.829 and 0.994, with good prediction efficiency. Conclusion The clinical value of predicting liver failure after primary hepatocellular carcinoma resection based on 2D-SWE is high. International standardized ratios of 1.01 and above, tumor sizes of 4.82 cm and above, and liver hardness values of 10.66 kPa and above are independent risk factors for liver failure after primary hepatocellular carcinoma resection.
- Primary hepatocellular carcinoma /
- Resection /
- Liver failure /
- Two dimensional shear wave elastography

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图 1 国际标准化比值、肿瘤大小、肝脏硬度值预测原发性肝细胞癌的ROC曲线

Figure 1. International normalized ratio, tumor size and liver hardness value predicted ROC curve of primary hepatocellular carcinoma

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表 1 肝衰竭组和非肝衰竭组患者一般资料比较

Table 1. Comparison of general data between liver failure group and nonliver failure group

组别	例数	性别[例(%)]		年龄(x±s，岁)	白蛋白(x±s，g/L)	总胆红素(x±s，μmol/L)	谷丙转氨酶(x±s，U/L)	天冬氨酸转氨酶(x±s，U/L)	γ-谷氨酰转移酶(x±s，U/L)
组别	例数	男性	女性	年龄(x±s，岁)	白蛋白(x±s，g/L)	总胆红素(x±s，μmol/L)	谷丙转氨酶(x±s，U/L)	天冬氨酸转氨酶(x±s，U/L)	γ-谷氨酰转移酶(x±s，U/L)
肝衰竭组	35	32(91.43)	3(8.57)	56.22±8.94	37.55±6.23	15.72±2.49	32.26±5.39	37.31±6.42	76.48±16.55
非肝衰竭组	145	129(88.97)	16(11.03)	55.64±8.62	39.82±5.97	13.28±1.78	32.19±4.94	33.25±5.39	53.30±13.95
统计量		0.014^a		0.354^b	2.002^b	6.693^b	0.074^b	3.849^b	8.499^b
P值		0.905		0.723	0.047	< 0.001	0.941	< 0.001	< 0.001

组别	例数	凝血酶原时间(x±s，s)	国际标准化比值(x±s)	Child-Pugh评分(x±s，分)	MELD评分(x±s，分)	肿瘤大小(x±s，cm)	肝门阻断[例(%)]		肝脏硬度值(x±s，kPa)
组别	例数	凝血酶原时间(x±s，s)	国际标准化比值(x±s)	Child-Pugh评分(x±s，分)	MELD评分(x±s，分)	肿瘤大小(x±s，cm)	有	无	肝脏硬度值(x±s，kPa)
肝衰竭组	35	12.16±1.13	1.03±0.06	6.00±1.00	7.56±1.25	5.32±0.87	12(34.29)	23(65.71)	12.99±1.47
非肝衰竭组	145	11.24±0.89	0.96±0.04	5.00±0.00	6.64±1.04	4.21±0.74	7(4.83)	138(95.17)	8.16±0.91
统计量		5.194^b	8.349^b	12.149^b	4.510^b	7.689^b	22.888^a		24.648^b
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001		< 0.001
注：^a为χ²值，^b为t值。

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表 2 原发性肝细胞癌切除术后肝衰竭的变量赋值

Table 2. Variable assignment of liver failure after resection of primary hepatocellular carcinoma

变量	赋值方法
因变量
肝衰竭	未发生=0，发生=1
自变量
白蛋白	>37.75 g/L=0，≤37.75 g/L=1
总胆红素	< 14.24 μmol/L=0，≥14.24 μmol/L=1
谷草转氨酶	< 35.26 U/L=0，≥35.26 U/L=1
γ-谷氨酰转移酶	< 69.29 U/L=0，≥69.29 U/L=1
凝血酶原时间	< 11.57 s=0，≥11.57 s=1
国际标准化比值	< 1.01=0，≥1.01=1
Child-Pugh评分	< 5.44分=0，≥5.44分=1
MELD评分	< 6.85分=0，≥6.85分=1
肿瘤大小	< 4.82 cm=0，≥4.82 cm=1
肝门阻断	无=0，有=1
肝脏硬度值	< 10.66 kPa=0，≥10.66 kPa=1

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表 3 原发性肝细胞癌切除术后肝衰竭的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of liver failure after primary hepatocellular carcinoma resection

变量	β	SE	Wald χ²	P值	OR值	95% CI
白蛋白	1.147	0.628	3.336	0.068	3.149	0.920~10.782
总胆红素	1.074	0.593	3.280	0.071	2.927	0.916~9.358
谷草转氨酶	0.963	0.528	3.326	0.069	2.620	0.931~7.373
γ-谷氨酰转移酶	0.854	0.493	3.001	0.084	2.349	0.894~6.174
凝血酶原时间	0.702	0.481	2.130	0.145	2.018	0.786~5.180
国际标准化比值	1.625	0.417	15.186	< 0.001	5.078	2.243~11.500
Child-Pugh评分	0.742	0.501	2.193	0.139	2.100	0.787~5.607
MELD评分	0.803	0.526	2.331	0.128	2.232	0.796~6.259
肿瘤大小	1.598	0.511	9.779	0.002	4.943	1.816~13.458
肝门阻断	0.884	0.573	2.380	0.124	2.421	0.787~7.442
肝脏硬度值	1.624	0.476	11.640	0.001	5.073	1.996~12.897

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表 4 国际标准化比值、肿瘤大小、肝脏硬度值预测原发性肝细胞癌的价值

Table 4. Value of international normalized ratio, tumor size and liver hardness value in predicting primary hepatocellular carcinoma

指标	AUC	95% CI	P值	截断值	约登指数	灵敏度(%)	特异度(%)
国际标准化比值	0.791	0.724~0.848	< 0.001	1.010	0.556	71.40	84.10
肿瘤大小	0.829	0.766~0.881	< 0.001	4.820	0.557	74.30	81.40
肝脏硬度值	0.994	0.968~1.000	< 0.001	10.660	0.965	97.10	99.30

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