Value of antithrombin Ⅲ in prediction of liver failure after hepatocellular carcinoma operation
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摘要:目的 探讨肝细胞癌患者术前血清抗凝血酶Ⅲ(AT-Ⅲ)在预测术后发生肝功能衰竭的应用价值。方法 将本院接受肝癌手术的31例患者根据术后肝功能恢复情况分为肝衰竭组(n=7)和非衰竭组(n=24)。比较2组常规肝功能指标及AT-Ⅲ活性，探讨影响肝癌术后肝功能衰竭的危险因素。结果 2组总胆红素、AT-Ⅲ活性、白蛋白、血小板、国际标准化比值差异有统计学意义(P < 0.05)。Logistic多因素分析显示，总胆红素、AT-Ⅲ是术后肝衰竭的独立危险因素(P < 0.05)。ROC曲线分析表明, AT-Ⅲ预测术后肝功能衰竭的最佳临界值为87.2%, 其灵敏度和特异度分别为0.807和0.716, 与血清总胆红素相比差异有统计学意义(P < 0.05)。结论 AT-Ⅲ是肝癌术后发生肝衰竭的独立危险因素，其在预测术后肝衰竭的灵敏度和特异度较血清总胆红素高。Abstract:Objective To explore the application value of preoperative serum antithrombin Ⅲ(AT-Ⅲ) in predicting postoperative liver failure in patients with hepatocellular carcinoma.Methods A total of 31 patients who underwent liver cancer surgery in our hospital were divided into hepatic failure group and non-failure group according to the recovery of liver function after hepatectomy. The routine liver function indexes and AT-Ⅲ activity were compared between the two groups, and the risk factors of hepatic failure after hepatectomy were explored.Results There were significant differences in total bilirubin, AT-Ⅲ activity, albumin, platelet and international standardized ratio between the two groups (P < 0.05). Logistic multivariate analysis showed that total bilirubin and AT-Ⅲ were independent risk factors of liver failure after hepatectomy (P < 0.05). ROC curve analysis showed that the best critical value of AT-Ⅲ for predicting liver failure after operation was 87.2%. The sensitivity and specificity were 0.807 and 0.716, respectively, which showed a significant difference compared with serum total bilirubin (P < 0.05).Conclusion AT-Ⅲ is an independent risk factor for hepatic failure after hepatocellular carcinoma operation, which has higher sensitivity and specificity in predicting hepatic failure after operation than serum total bilirubin.
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表 1 2组临床资料比较
临床指标 非PHLF(n=24) PHLF(n=7) z/t/χ2 P值 年龄/岁 55.3±12.6 57.8±9.1 t=0.413 0.359 性别 男 22 6 χ2=0.220 0.550 女 2 1 HBsAg 阳性 18 5 χ2=0.036 0.600 阴性 6 2 AFP/(ng/mL) ≥20 15 5 χ2=0.189 0.516 < 20 9 2 术前TACE术 是 7 2 χ2=0.001 0.681 否 17 5 肝硬化 是 15 4 χ2=0.066 0.565 否 9 3 ALT/(U/L) 68.0(34.0, 147.0) 76.0(44.5, 167.3) z=-1.475 0.103 总胆红素/(μmol/L) 11.4±4.2 17.5±6.1 t=2.431 0.012 AT-Ⅲ活性/% 104.2±8.9 79.7±11.8 t=7.732 < 0.001 白蛋白/(g/L) 39.1±2.3 31.4±4.2 t=3.129 < 0.001 血小板/(×109/L) 175.5±54.6 113.2±49.8 t=8.187 < 0.001 INR 1.1±0.2 1.2±0.2 t=2.874 < 0.001 凝血酶原时间/s 12.9±1.4 17.8±2.1 t=2.231 0.024 r-GT/(U/L) 46.1±11.2 154.0±22.1 t=5.128 < 0.001 肿瘤大小/cm 3.5±2.1 3.5±1.7 t=0.733 0.238 肿瘤数量 ≥2个 8 2 χ2=0.056 0.599 < 2个 16 5 切除范围 ≥3肝段 10 3 χ2=0.003 0.642 < 3肝段 14 4 肝门阻断 是 15 5 χ2=0.189 0.516 否 9 2 阻断时间/min 25.0±12.0 21.0±19.0 t=0.587 0.348 出血量/mL 612.2±217.9 654.6±312.4 t=0.745 0.273 AFP: 血清甲胎蛋白; HBsAg: 乙型肝炎病毒表面抗原; AT-Ⅲ: 抗凝血酶Ⅲ; INR: 国际标准化比值; r-GT: r-谷氨酰胺转肽酶。 
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表 2 术后肝功能衰竭危险因素Logistic多因素分析
指标 B值 标准误差 优势比 95% CI P值 总胆红素/(μmol/L) 0.796 0.312 1.143 0.348~1.419 < 0.05 AT-Ⅲ活性/% -2.130 0.482 3.761 1.274~13.832 < 0.05 白蛋白/(g/L) 0.348 0.512 0.769 0.438~1.641 >0.05 r-GT/(U/L) 0.483 0.518 0.624 0.208~0.970 >0.05 凝血酶原时间/s -0.130 0.315 0.675 0.540~1.043 >0.05 血小板/(×109/L) -0.025 0.018 0.732 0.671~0.917 >0.05 INR 1.328 1.381 2.617 0.312~31.762 >0.05 AT-Ⅲ: 抗凝血酶Ⅲ; r-GT: r-谷氨酰胺转肽酶; INR: 国际标准化比值。
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