应用瞬态弹性成像预测乙型肝炎相关肝癌患者的肝切除后肝

StephenW

BMC Gastroenterol. 2017 Dec 29;17(1):171. doi: 10.1186/s12876-017-0732-4.
Prediction of posthepatectomy liver failure using transient elastography in patients with hepatitis B related hepatocellular carcinoma.Lei JW1, Ji XY2, Hong JF1,3, Li WB4, Chen Y1, Pan Y5, Guo J6.
Author information
1Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital (EHBH), Second Military Medical University, Shanghai, China.2People's Liberation Army Military Academy, Second Military Medical University, Shanghai, China.3Department of Ultrasound, FuZhou General Hospital (Dongfang Hospital), Xiamen University, Fuzhou, Fujian, China.4Department of Ultrasound, Shanghai First People's Hospital, Shanghai, China.5Department of Ultrasound, Yuhuangding Hospital, Yantai, Shandong, China.6Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital (EHBH), Second Military Medical University, Shanghai, China. [email protected].

AbstractBACKGROUND: It is essential to accurately predict Postoperative liver failure (PHLF) which is a life-threatening complication. Liver hardness measurement (LSM) is widely used in non-invasive assessment of liver fibrosis. The aims of this study were to explore the application of preoperative liver stiffness measurements (LSM) by transient elastography in predicting postoperative liver failure (PHLF) in patients with hepatitis B related hepatocellular carcinoma.
METHODS: The study included 247 consecutive patients with hepatitis B related hepatocellular carcinoma who underwent hepatectomy between May 2015 and September 2015. Detailed preoperative examinations including LSM were performed before hepatectomy. The endpoint was the development of PHLF.
RESULTS: All of the patients had chronic hepatitis B defined as the presence of hepatitis B surface antigen (HBsAg) for more than 6 months and 76 (30.8%) had cirrhosis. PHLF occurred in 37 (14.98%) patients. Preoperative LSM (odds ratio, OR, 1.21; 95% confidence interval, 95% CI: 1.13-1.29; P < 0.001) and international normalized ratio (INR) (OR, 1.07; 95% CI: 1.01-1.12; P < 0.05) were revealed to be independent risk factors for PHLF, and a new model was defined as LSM-INR index (LSM-INR index = 0.191*LSM + 6.317*INR-11.154). The optimal cutoff values of LSM and LSM-INR index for predicting PHLF were 14 kPa (AUC 0.86, 95% CI: 0.811-0.901, P < 0.001) and -1.92 (AUC 0.87, 95% CI: 0.822-0.909, P < 0.001), respectively.
CONCLUSIONS: LSM can be helpful for surgeons to make therapeutic decisions in patients with hepatitis B related hepatocellular carcinoma.


KEYWORDS: Hepatectomy; Hepatitis B; Hepatocellular carcinoma; Liver stiffness measurement; Posthepatectomy liver failure

PMID:29284411DOI:10.1186/s12876-017-0732-4

StephenW

MC Gastroenterol。 2017年12月29日; 17（1）：171。 doi：10.1186 / s12876-017-0732-4。
应用瞬态弹性成像预测乙型肝炎相关肝癌患者的肝切除后肝功能衰竭。
Lei JW1，Ji XY2，Hong JF1,3，Li WB4，Chen Y1，Pan Y5，Guo J6。
作者信息

1
    第二军医大学东方肝胆外科医院超声科，上海
2
    第二军医大学解放军军事学院，中国上海。
3
    厦门大学福州总医院（东方医院）超声科，福建福州
4
    上海第一人民医院超声科，上海，中国。
五
    山东烟台毓璜顶医院超声科
6
    第二军医大学东方肝胆外科医院超声科，上海[email protected]。

抽象
背景：

准确预测危及生命的并发症术后肝功能衰竭（PHLF）至关重要。肝硬度测量（LSM）广泛用于肝脏纤维化的无创评估。本研究的目的是探讨临时性弹性成像术前肝硬度测量（LSM）在预测乙型肝炎相关肝细胞癌患者术后肝功能衰竭（PHLF）中的应用。
方法：

本研究纳入2015年5月至2015年9月接受肝切除术的连续247例乙型肝炎相关肝癌患者。术前进行包括LSM在内的详细术前检查。终点是PHLF的发展。
结果：

所有患者均有慢性乙型肝炎定义为乙型肝炎表面抗原（HBsAg）超过6个月，76例（30.8％）为肝硬化。发生PHLF的有37例（14.98％）。术前LSM（OR，1.21,95％置信区间，95％CI：1.13-1.29，P <0.001）和国际标准化比值（INR）（OR，1.07,95％CI：1.01-1.12; P <0.05） ）是PHLF的独立危险因素，新定义为LSM-INR指数（LSM-INR指数= 0.191 * LSM + 6.317 * INR-11.154）。 LSM和LSM-INR指数预测PHLF的最佳截断值为14kPa（AUC0.86,95％CI：0.811-0.901，P <0.001）和-1.92（AUC0.87,95％CI：0.822-0.909，P < 0.001）。
结论：

LSM可以帮助外科医生在乙型肝炎相关肝细胞癌患者中做出治疗决定。
关键词：

肝切除术;乙型肝炎;肝细胞癌;肝硬度测量;肝切除后肝功能衰竭

结论：
    29284411
DOI：
    10.1186 / s12876-017-0732-4