摘要目的 探讨术前天冬氨酸转氨酶/血小板比值指数(APRI)联合吲哚氰绿(ICG)试验对巴塞罗那(BCLC)-B期肝细胞肝癌(HCC)患者肝切除术后肝衰竭(PHLF)的指导价值.方法 分析行肝切除术的BCLC-B期HCC患者216例的临床资料,利用受试者工作特征(ROC)曲线获得APRI值最佳截点,采用logistic回归模型进行单因素及多因素分析识别PHLF的独立预测因素.根据BCLC-B期HCC患者肝切术后是否发生肝衰竭分为肝衰竭组与非肝衰竭组,记录并分析两组患者吲哚氰绿15分钟滞留率(ICGR15)、APRI的差异.结果 纳入本研究的216例BCLC-B期HCC患者,共30例(12.9％)发生PHLF.logistic回归模型单因素及多因素分析表明,APRI、ICGR15与PHLF均有显著相关性(P＜0.05),ROC曲线分析显示APRI对PHLF有较强的预测能力(曲线下面积为0.831,敏感度为93.3％,特异度为65.6％),最佳截断点是0.59.其中APRI-ICGR15联合的受试者工作特征曲线下面积(AUC)高于APRI或ICGR15单个指标,而APRI和ICGR15的AUC相近.对于BCLC-B期HCC患者,当APRI＜0.59且ICGR15＜ 10％时,PHLF发生率低;当APRI≥0.59且ICGR15＜ 10％,或APRI＜0.59且ICGR15≥10％时,PHLF发生率稍高,此时手术治疗需谨慎,术前应积极纠正肝脏功能,术后给予积极支持治疗;当APRI≥0.59且ICGR15≥10％时,PHLF发生率较高,暂不建议手术治疗.结论 ICGR15、APRI是评估肝脏储备功能的良好指标,两者相结合能更好的评估BCLC-B期HCC患者PHLF的风险.

abstractsObjective Analysis the date of patients with stage B Primary hepatocellular carcinoma in Barcelona Clinical Liver Classification (BCLC-B),and to explore the value of aspartate transaminase and platelet ratio index (APRI) combined with the indocyanine green retention rate at 15 mins (ICGR15)in evaluating the risk of the posthepatectomy liver failure (PHLF) for BCLC-B.Methods Analysis of clinical data of 216 patients with BCLC-B hepatocellular carcinoma undergoing hepatectomy.The best cut-off point of APRI value was obtained by receiver operating characteristic (ROC) curve.the logistic regression model was used to identify independent predictive indices for PHLF.According to whether Postopeatectomy Liver Failure (PHLF),they were divided into hepatic failure group and non-hepatic failure group.The differences in clinical biochemical parameters,ICGR15 and APRI between the two groups were recorded and analyzed.Results A total of 216 patients were enrolled in this study,among whom 30 (12.9％) had PHLF.he univariate and multivariate analyses showed that APRI and ICGR15 were significantly associated with the prognosis of PHLF patients (P ＜0.01).The ROC curve analysis shows that APRI has a strong ability to predict PHLF (The area under the curve is 0.831,the sensitivity is 93.3％,and the specificity is 65.6％),and the best cut-off point is 0.59.APRI-ICGR15 had a significantly higher area under the receiver operating characteristic curve (AUC)than APRI or ICGR15,and The AUC of APRI and ICGR15 are similar.For patients with BCLC-B stage hepatocellular carcinoma (HCC),when APRI ＜ 0.59 and ICGRI5 ＜ 10％,the incidence of liver failure after hepatectomy is low;when APRI≥0.59 and ICGR15 ＜ 10％,or APRI ＜ 0.59 and ICGR15 ≥ 10％ at that time,the incidence of PHLF is slightly higher.At this time,surgical treatment should be cautious.Liver function should be actively corrected before operation,and active supportive treatment should be given after surgery.When APRI≥0.59 and ICGR15≥10％,the incidence of PHLF is higher.Surgical treatment is not recommended for the time being.Conclusion ICGR15 and APRI are good indicators for evaluating liver reserve function.The combination of the two can better evaluate the risk of postoperative liver failure in patients with BCLC-B HCC.