摘要目的 比较白蛋白-胆红素(ALBI)评分与Child-Pugh (CP)评分预测肝细胞癌(HCC)患者肝切除术后发生肝功能衰竭(PHLF)的效果,探讨ALBI评分的临床应用价值.方法 收集2011年1月至2016年12月南方医科大学南方医院因HCC行肝切除术患者的临床资料,运用logistic回归分析PHLF的危险因素.在此基础上分别分析ALBI评分与CP评分预测PHLF的发生情况,通过受试者工作特征曲线(ROC)比较ALBI评分与CP评分对PHLF的预测能力.结果 共有1013例HCC患者纳入本研究,PHLF发生率为17.7％(179/1013).多因素logistic回归分析结果显示CP评分(OR值=1.94,P＜0.05)及ALBI评分(OR值=3.85,P＜0.05)分级较高均为PHLF的独立危险因素.CP-A级和B级患者PHLF发生率分别为16.4％(158/963)和42％(21/50),两组差异有统计学意义(P＜0.05).ALBI-1级、2级、3级患者PHLF发生率分别为9.9％ (50/504)、24.8％(124/501)、62.5％ (5/8),差异具有统计学意义(P＜0.05).ALBI评分可将CP-A级患者细分为ALBI 1-A与2-A级,其PHLF发生率分别为9.9％ (50/504)、23.5％ (108/459),差异有统计学意义(P＜0.05).CP评分ROC曲线下面积为0.630,ALBI评分ROC曲线下面积为0.705,差异有统计学意义(P＜0.05).结论 ALBI评分较CP评分对HCC手术患者PHLF的发生具有更好的预测效果,对CP-A级患者能更为准确地预测PHLF.ALBI评分是预测PHLF的有效手段.

abstractsObjective To compare the discriminatory power of the Albumin-bilirubin score (ALBI) and the Child-Pugh score (CP) in predicting post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC) after curative liver resection,and to explore the clinical value of ALBI score.Methods The clinical data of HCC patients who underwent curative hepatectomy in Nanfang Hospital,Southern Medical University from January 2011 to December 2016 were retrospectively reviewed.The risk factors of PHLF were identified through logistic regression.The areas under the receiver operating characteristic (ROC) curve were calculated to measure the ALBI and CP scores in the prediction of PHLF.Results A total of 1 013 patients were enrolled.The incidence of PHLF was 17.7％ (179/1013).Both CP score (OR =1.94,P ＜ 0.05) and ALBI score (OR =3.85,P ＜ 0.05) were identified as independent predictors of PHLF on multivariable analysis.The incidence of PHLF in patients with CP grade A was significantly lower than those with CP grade B(16.4％,158/963 vs.42％,21/50;P ＜ 0.05).The incidences of PHLF in patients with AIBI 1,2 and 3 were 9.9％ (50/504),24.8％ (124/501) and 62.5％ (5/8),respectively (P ＜0.05),indicating that the incidences of PHLF increased significantly with increasing ALBI grades.Moreover,when the ALBI score further classified patients of the CP grade A into the ALBI 1-A and ALBI 2-A subgroups,the incidence of PHLF in patients with ALBI 1-A was significantly lower than that with ALBI 2-A (9.9％,50/504 vs.23.5％,108/459;P ＜0.05).The area under the ROC curve for the ALBI score in predicting PHLF was greater than that of the CP score (0.705 vs.0.630;P ＜ 0.05).Conclusions The prognostic power of the ALBI score was greater than that of the CP score in predicting PHLF.Even in patients with CP grade A,the ALBI score was more sensitive in identifying patients with a high risk of PHLF.The ALBI score is a useful tool to predict PHLF after hepatectomy in HCC patients.