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目的:比较Child-Pugh分级标准(CP)、终末期肝病模型(MELD)和白蛋白-胆红素评分模型(ALBI)预测肝癌患者R_0切除术后发生肝衰竭(PHLF)的能力。方法:收集2010年9月—2015年11月符合研究标准的275例肝癌行肝癌R_0切除术的患者资料,应用受试者工作特征曲线(ROC)分析方法,比较3种评分预测发生PHLF的准确性。结果:依据50-50标准,275例患者中43例被诊断为PHLF,ALBI、CP、MELD诊断PHLF的ROC曲线下面积(AUROC)(95%CI)分别为0.930(0.893~0.957)、0.795(0.743~0.841)、0.736(0.680~0.787)(ALBI vs.CP:P=0.0003;ALBI vs.MELD:P=0.0001;CP vs.MELD:P=0.2420)。依据国际肝脏外科学组(ISGLS)标准,275例患者中48例被诊断为PHLF,ALBI、CP、MELD诊断PHLF的AUROC(95%CI)分别为0.884(0.840~0.920)、0.828(0.778~0.871)、0.762(0.707~0.811)(ALBI vs.CP:P=0.1542;ALBI vs.MELD:P=0.0064;CP vs.MELD:P=0.2010)。按肝切除范围分亚组分析的结果与全组分析的结果基本一致。结论:3种评分系统中,ALBI评分预测肝癌患者R_0切除术后PHLF优于CP和MELD,MELD评分(由于分数构成中肌酐权重较大)相对不适用于轻症早期肝癌患者。
PURPOSE: To compare the ability of Child-Pugh classification (CP), end-stage liver disease (MELD) and albumin-bilirubin scoring model (ALBI) to predict the occurrence of liver failure (PHLF) after R0 resection in patients with liver cancer. Methods: The data of 275 patients with hepatocellular carcinoma who underwent resection of liver cancer R00 in our hospital from September 2010 to November 2015 were collected. The receiver operating characteristic curve (ROC) analysis was used to compare the accuracy of the three predictors of PHLF Sex. Results: According to the criteria of 50-50, 43 cases of PHLF were diagnosed in 275 cases, and the area under the curve of AUROC (95% CI) of PHLF diagnosed by ALBI, CP and MELD were 0.930 (0.893-0.9575) and 0.795 0.743-0.841), 0.736 (0.680-0.787) (ALBI vs.CP: P = 0.0003; ALBI vs.MELD: P = 0.0001; CP vs.MELD: P = 0.2420). According to International Society for Hepatology (ISGLS), 48 of 275 patients were diagnosed as PHLF. The AUROC (95% CI) of ALB, CP and MELD for diagnosis of PHLF were 0.884 (0.840-0.920) and 0.828 (0.778-0.871 ), 0.762 (0.707-0.811) (ALBI vs. CP: P = 0.1542; ALBI vs. MELD: P = 0.0064; CP vs. MELD: P = 0.2010). According to the range of liver resection sub-sub-analysis of the results and the results of the whole group of analysis are basically the same. CONCLUSION: The ALBI score predicts PHLF is superior to CP and MELD after R0 resection in patients with liver cancer. The MELD score (due to the larger weight of creatinine in the score structure) is not suitable for patients with mild early stage liver cancer.