五种评分系统判断TACE术治疗原发性肝癌患者发生肝功能不全效能比较研究

doi:10.3969/j.issn.1672-5069.2021.01.029

摘要/Abstract

摘要： 目的比较CTP评分、终末期肝病模型(MELD)、MELD联合吲哚菁绿(ICG)清除试验(MELD-ICG)评分、慢性肝功能不全(CLD)评分和改良的白蛋白胆红素(mALBI)评分预测经肝动脉化疗栓塞(TACE)治疗的原发性肝癌(PLC)患者术后发生早期肝功能不全的效能。方法 2018年12月～2019年12月我院收治的87例PLC患者,均接受TACE治疗,分别计算术前CTP、MELD、MELD-ICG、CLD和ALBI五种模型评分,随访术后发生肝功能失代偿情况。绘制受试者工作曲线(ROC)并计算曲线下面积(AUC)对五种评分的预测效能作出比较。结果在87例患者中,术后发生肝功能不全27例(31.0%);术前,肝功能不全组CTP、MELD、MELD-ICG、CLD和mALBI评分分别为(6.9±1.1)、12.0(10.0～14.0)、27.4(20.2～35.0)、(1.5±0.9)和(2.6±1.5),显著高于60例肝功能代偿组; CTP、MELD、MELD-ICG、CLD和mALBI评分预测的AUC分别为:0.708、0.787、0.827、0.735和0.723,其中MELD-ICG预测术后发生肝功能不全的AUC为0.827(95%CI:0.730～0.899),显著高于CTP或CLD或mALBI。结论 CTP、MELD、MELD-ICG、CLD和mALBI五种评分系统均是预测PLC患者TACE术后发生肝功能不全的有效工具,但以MELD-ICG评分的预测价值最佳。

关键词: 原发性肝癌, 肝动脉化疗栓塞, 肝功能不全, 肝功能预测模型

Abstract: Objective The aim of this study was to compare CTP score, end-stage liver disease model (MELD), MELD combined with indocyanine green (ICG) clearance test (MELD-ICG) score, chronic liver dysfunction (CLD) score and modified albumin bilirubin (mALBI) scores for predicting early liver dysfunction in patients with primary liver cancer (PLC) undergoing transhepatic arterial chemoembolization (TACE). Methods A retrospective analysis was performed in 87 PLC patients underwent TACE treatment in our hospital from December 2018 through December 2019, and the preoperative CTP, MELD, MELD-ICG, CLD and ALBI scores were calculated. The area under receiver operating curve (AUC) was applied to predict the incidence of liver dysfunction. Results 27 (31.0%) out of 87 patients with PLC after TACE developed postoperative hepatic insufficiency in our series; the preoperative CTP, MELD, MELD-ICG, CLD and ALBI scores in the 27 patients with hepatic insufficiency were (6.9±1.1), 12.0 (10.0 -14.0), 27.4 (20.2-35.0), (1.5±0.9) and (2.6±1.5), significantly higher than in 60 patients with compensated liver functions; the AUC of CTP, MELD, MELD-ICG, CLD and mALBI were 0.708, 0.787, 0.827, 0.735 and 0.723, with the AUC of MELD-ICG in predicting postoperative hepatic insufficiency highest [0.827 (95% CI: 0.730-0.899), significantly higher than CTP or CLD or mALBI .Conclusion The five scoring systems of CTP, MELD, MELD-ICG, CLD and mALBI are all efficacious tools for predicting hepatic dysfunction after TACE in patients with PLC, and the MELD-ICG score has the best predictive value and needs further investigation.

Key words: Primary liver cancer, Transhepatic arterial chemoembolization, Liver dysfunction, Liver function predicting scoring system

张雪, 胥莹, 安文慧, 张帮婷, 杨雪芳. 五种评分系统判断TACE术治疗原发性肝癌患者发生肝功能不全效能比较研究[J]. 实用肝脏病杂志, 2021, 24(1): 111-114.

Zhang Xue, Xu Ying, An Wenhui,et al. Value of five scoring systems in predicting liver dysfunction after transcatheter arterial chemoembolization in patients with primary liver cancer[J]. Journal of Practical Hepatology, 2021, 24(1): 111-114.

参考文献

[1] Pimpin L, Cortez-pinto H, Negro F, et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J Hepatol, 2018,69(3),718-735.
[2] Galle PR, Forner A, Llovert JM, et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol, 2018,69(1),182-236.
[3] Subastri A,Suyavaran A,Preedia BE,et al. Troxerutin with copper generates oxidative stress in cancer cells:Its possible chemotherapeutic mechanism against hepatocellular carcinoma. J Cell Physiol,2018,233(3):1775-1790.
[4] 赵晓光, 史玉洁. 应用还原型谷胱甘肽预防处理接受TACE治疗的中晚期原发性肝癌患者对肝功能的影响. 实用肝脏病杂志, 2019, 22(3):128-131.
[5] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版). 中华消化外科杂志, 2017, 16(7):635-647.
[6] Min YW, Kin J, Kin S, et al. Risk factors and a predictive model for acute hepatic failure after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Liver Int, 2013, 33(2):197-202.
[7] 中国医师协会介入医师分会. 中国肝细胞癌经动脉化疗栓塞治疗(TACE)临床实践指南. 中华肝脏病杂志, 2019, 27(3):172-181.
[8] Khisti R , Patidar Y , Garg L , et al. Correlation of baseline portal pressure (hepatic venous pressure gradient) and indocyanine green clearance test with post-transarterial chemoembolization acute hepatic failure. J Clin Exp Hepatol, 2018,9:4.
[9] Gurusamy KS, Tsochatzis E, Thorburn D, et al. Management of people with intermediate-stage hepatocellular carcinoma: a network meta-analysis. The Cochrane Library, 2015.
[10] Shalimar T, Subrat Acharya K, William Lee M. Worldwide differences in acute liver failure. Critical care in acute liver failure. London: Future Medicine Ltd, 2013:32-46.
[11] Zipprich A, Kuss O, Rogowski S , et al. Incorporating indocyanin green clearance into the model for end stage liver disease (MELD-ICG) improves prognostic accuracy in intermediate to advanced cirrhosis. Gut, 2010, 59(7):963-968.
[12] Philip JJ , Sarah B , Chiaki K, et al. Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach--The ALBI grade. J Clin Oncol, 2015, 33(6):550-558.
[13] 贾克丽, 韩际奥, 高晓. 血清前白蛋白和MELD评分对失代偿期乙型肝炎肝硬化患者预后的预测价值. 实用肝脏病杂志, 2018, 21(3): 348-351.
[14] Levesque E, Eléonore M, Dudau D, et al. Current use and perspective of indocyanine green clearance in liver diseases. Anaesth Crit Care Pain Med, 2015, 35(1):49-57.
[15] 中国研究型医院学会肝胆胰外科专业委员会. 肝硬化患者肝切除术后肝功能不全的预防与治疗专家共识(2019版). 中华消化外科杂志, 2019, 18(4):297-302.
[16] Nagashima I1, Takada T, Okinaga K, et al.A scoring system for the assessment of the risk of mortality after partial hepatectomy in patients with chronic liver dysfunction .J Hepatobiliary Pancreat Surg, 2005, 12(1): 44-48.
[17] Hou LJ,Zhao HC. Progress of diagnosis and treatment of liver insufficiency after liver resection. J Hepatobiliary Surg,2015,34(3):82-84.
[18] Lo CH, Liu MY, Lee MS, et al. Comparison between Child-Turcotte-Pugh and albumin-bilirubin scores in assessing the prognosis of hepatocellular carcinoma after stereotactic ablative radiation therapy. Int J Radiation Oncol Biol Phys, 2017, 99(1):145.
[19] Khabbaz RC,Lokken RP,Chen YF,et al. Albumin-bilirubin and platelet-albumin-bilirubin grades do not predict survival after transjugular intrahepatic portosystemic shunt creation. Cardiovasc Intervent Radiol, 2018,41(7):1029–1034.
[20] Ronald J, Wang Q, Choi SS, et al. Albumin-bilirubin grade versus MELD score for predicting survival after transjugular intrahepatic portosystemic shunt (TIPS) creation. Diagn Interv Imaging, 2018,99(3):163–168.