TSP-1和TGF-β在肝切除术后肝衰竭预测中的价值

doi:10.3877/cma.j.issn.2095-3232.2019.02.015

目的

探讨肝切除术后血浆血小板反应素-l（TSP-1）和TGF-β在预测肝切除术后肝衰竭（PHLF）的价值。

方法

回顾性分析2017年10月至2018年3月在新疆医科大学第一附属医院收治的50例肝切除术患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男29例，女21例；平均年龄（41±14）岁。按术中切除肝段的数量是否≥3个，将患者分为大范围肝切除术组（大范围组，37例）和小范围肝切除术组（小范围组，13例）。观察两组围手术期血浆TSP-1和TGF-β动态变化。按"50-50标准"判定PHLF，并采用受试者工作特征（ROC）曲线分析TSP-1、TGF-β水平对PHLF的预测价值。两组TSP-1、TGF-β比较采用t检验或Mann-Whitney秩和检验，率的比较采用χ²检验或Fisher确切概率法。

结果

本组患者PHLF发生率20%（10/50），其中大范围组发生率为27%（10/37），明显高于小范围组的0 （P<0.05）。大范围组术后1、2、5、7 d血浆TSP-1水平分别为3 417 （974，7 090）、3 425（819，4 961）、3 347（815，4 957）、3 526（1 213，8 715）μg/L，明显高于小范围组的891（388，1 695）、1 094（572，1 476）、1 097（736，1 611）、1 061（479，1 642）μg/L （Z=2.621，2.245，2.190，3.354；P<0.05）。大范围组术后2、7 d血浆TGF-β为2.57（1.52，4.08）、3.56（1.46，4.60）μg/L，明显高于小范围组的1.52（1.20，2.20）、1.50（1.13，1.65）μg/L（Z=2.444, 2.691；P<0.05）。术后1 d血浆TSP-1诊断PHLF的ROC曲线下面积为0.88，敏感度为1.00，特异度为0.75。

结论

大范围肝切除术患者术后血浆TSP-1和TGF-β明显升高，且肝切除范围与PHFL发生有关。术后1 d血浆TSP-1水平可作为预测PHLF有效的参考指标。

关键词: 肝切除术, 血小板反应素-1, 转化生长因子-β, 肝功能衰竭

Objective

To explore the value of plasma thrombospondin-l (TSP-1) and transforming growth factor-β (TGF-β) in predicting posthepatectomy liver failure (PHLF).

Methods

Clinical data of 50 patients undergoing hepatectomy in the First Affiliated Hospital of Xinjiang Medical University from October 2017 to March 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 29 patients were male and 21 female,aged (41±14) years on average. According to whether the number of the resected segments was≥3, all patients were divided into the extensive hepatectomy (extensive group, n=37) and limited hepatectomy groups (limited group, n=13). The dynamic changes of plasma levels of TSP-1 and TGF-β during the perioperative period were observed in two groups. PHLF was evaluated by the "50-50 criteria". The value of TSP-1 and TGF-β levels in predicting PHLF was analyzed by the receiver operating characteristic (ROC) curve. The TSP-1 and TGF-β levels were compared between two groups by t test or Mann-Whitney rank sum test. The rate comparison was carried out by Chi-square test or Fisher's exact test.

Results

The total incidence of PHLF was 20% (10/50), 27% (10/37) in the extensive group, significantly higher than 0 in the limited group (P<0.05). In the extensive group, the plasma levels of TSP-1 at postoperative 1, 2, 5 and 7 d were 3 417(974, 7 090), 3 425(819, 4 961), 3 347(815, 4 957) and 3 526(1 213, 8 715) μg/L, significantly higher compared with 891(388, 1 695), 1 094(572, 1 476), 1 097(736, 1 611) and 1 061(479, 1 642) μg/L in the limited group (Z=2.621, 2.245, 2.190, 3.354; P<0.05). The plasma levels of TGF-β at postoperative 2 and 7 d were 2.57(1.52, 4.08) and 3.56(1.46, 4.60) μg/L in the extensive group, significantly higher than 1.52(1.20, 2.20) and 1.50(1.13, 1.65) μg/L in the limited group (Z=2.444, 2.691; P<0.05). The area under ROC curve of plasma TSP-1 level at postoperative 1 d in the diagnosis of PHLF was 0.88, with sensitivity 1.00 and specificity 0.75.

Conclusions

The plasma levels of TSP-1 and TGF-β are significantly increased in patients undergoing extensive hepatectomy. The extent of hepatectomy is correlated with the incidence of PHLF. The plasma TSP-1 level at postoperative 1 d can be utilized as an effective reference index for predicting PHLF.

Key words: Hepatectomy, Thrombospondin-1, TGF-β, Liver failure

表1 大范围组和小范围组肝切除患者一般资料比较

组别	例数	性别（例）		年龄（岁，±s）	疾病种类（例）			Child-Pugh分级（例）
组别	例数	男	女	年龄（岁，±s）	包虫病	肝癌	血管瘤	A级	B级
大范围组	37	21	16	37±13	27	7	3	35	2
小范围组	13	8	5	47±14	4	3	6	2	1
统计值		χ²=0.090		t=-1.845	χ²=10.583			χ²=0.089
P值		0.764		0.071	0.005			0.765

表1 大范围组和小范围组肝切除患者一般资料比较

组别	例数	性别（例）		年龄（岁，±s）	疾病种类（例）			Child-Pugh分级（例）
组别	例数	男	女	年龄（岁，±s）	包虫病	肝癌	血管瘤	A级	B级
大范围组	37	21	16	37±13	27	7	3	35	2
小范围组	13	8	5	47±14	4	3	6	2	1
统计值		χ²=0.090		t=-1.845	χ²=10.583			χ²=0.089
P值		0.764		0.071	0.005			0.765

图1 大范围组和小范围组肝切除术后患者血浆TSP-1和TGF-β水平动态变化注：TSP-1为血小板反应素-l，a为P<0.05

图2 大范围组和小范围组肝切除术后患者血浆TSP-1和TGF-β水平与PHLF的关系注：TSP-1为血小板反应素-l，PHLF为肝切除术后肝衰竭，a为P<0.05

图3 血浆TSP-1、TGF-β水平预测肝切除患者PHLF的ROC曲线注：TSP-1为血小板生成素-l，PHLF为肝切除术后肝衰竭，AUC为曲线下面积，ROC为受试者工作特征

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Value of TSP-1 and TGF-β in predicting posthepatectomy liver failure

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Value of TSP-1 and TGF-β in predicting posthepatectomy liver failure