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中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (06) : 574 -578. doi: 10.3877/cma.j.issn.2095-3232.2021.06.009

临床研究

sST2对肝切除术后肝衰竭的预测价值及其影响因素
沙地克·阿帕尔1, 李涛2, 谷申森2, 阿米娜·艾尔肯3, 赵晋明1, 温浩1, 吐尔洪江·吐逊1,()   
  1. 1. 830054 乌鲁木齐,新疆医科大学第一附属医院消化血管外科中心 肝脏·腹腔镜外科;830011 乌鲁木齐,新疆医科大学省部共建中亚高发病成因与防治国家重点实验室
    2. 830054 乌鲁木齐,新疆医科大学第一附属医院消化血管外科中心 肝脏·腹腔镜外科
    3. 830011 乌鲁木齐,新疆医科大学健康管理院
  • 收稿日期:2021-07-08 出版日期:2021-09-23
  • 通信作者: 吐尔洪江·吐逊
  • 基金资助:
    国家自然科学基金(81560329); 新疆维吾尔自治区科技厅重点实验室开放课题项目(2018D03002); 新疆维吾尔自治区天山青年计划博士科技人才培养项目(2017Q094); 新疆医科大学省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2017-Y2)

Predictive value of sST2 and influencing factors for post-hepatectomy liver failure

Apaer Shadike·1, Tao Li2, Shensen Gu2, Aierken Amina·3, Jinming Zhao1, Hao Wen1, Tuxun Tuerhongjiang·1,()   

  1. 1. Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China; State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi 830011, China
    2. Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
    3. Institute of Health Management, Xinjiang Medical University, Urumqi 830011, China
  • Received:2021-07-08 Published:2021-09-23
  • Corresponding author: Tuxun Tuerhongjiang·
引用本文:

沙地克·阿帕尔, 李涛, 谷申森, 阿米娜·艾尔肯, 赵晋明, 温浩, 吐尔洪江·吐逊. sST2对肝切除术后肝衰竭的预测价值及其影响因素[J/OL]. 中华肝脏外科手术学电子杂志, 2021, 10(06): 574-578.

Apaer Shadike·, Tao Li, Shensen Gu, Aierken Amina·, Jinming Zhao, Hao Wen, Tuxun Tuerhongjiang·. Predictive value of sST2 and influencing factors for post-hepatectomy liver failure[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(06): 574-578.

目的

探讨血浆可溶性致癌性抑制基因2(sST2)对肝切除术后肝衰竭(PHLF)的预测价值及其影响因素。

方法

本前瞻性研究对象为2015年12月至2018年11月在新疆医科大学第一附属医院行肝切除术的141例患者。其中男75例,女66例;年龄33~54岁,中位年龄42岁。原发病:肝细胞癌31例,包虫病74例,肝血管瘤21例,其他疾病15例。患者均签署知情同意书,符合医学伦理学规定。采用ROC曲线确定sST2的最佳诊断界值,分析sST2对PHLF的预测价值。采用Logistic回归模型进行PHLF影响因素分析。

结果

sST2的最佳界值为3 676 ng/L,sST2升高组41例,sST2正常组100例。sST2升高组PHLF发生率为85%(35/41),明显高于sST2正常组的14%(14/100)(χ2=65.31,P<0.05)。术后第1天sST2水平预测PHLF的ROC曲线下面积为0.859,敏感度和特异度分别为0.85、0.87。多因素Logistic回归分析结果显示,大范围切除和术后第1天sST2升高是PHLF发生的独立危险因素(OR=16.476,1.001;P<0.05)。

结论

血浆sST2水平与PHLF相关,对PHLF发生具有良好的预测价值。

Objective

To evaluate the predictive value of plasma soluble suppression of tumorigenicity-2 (sST2) on post-hepatectomy liver failure (PHLF) and to explore the influencing factors of PHLF.

Methods

141 patients who underwent hepatectomy in the First Affiliated Hospital of Xinjiang Medical University from December 2015 to November 2018 were recruited in this prospective study. Among them, 75 cases were male and 66 female, aged from 33 to 54 years, with a median age of 42 years. The primary diseases were hepatocellular carcinoma (n=31), hydatid disease (n=74), hepatic hemangioma (n=21) and other diseases (n=15). The informed consents of all patients were obtained and the local ethical committee approval was received. ROC curve was delineated to determine the optimal diagnostic thresholds of sST2, and the predictive value of sST2 for PHLF was analyzed. The influencing factors of PHLF were identified using Logistic regression model.

Results

The optimal diagnostic thresholds of sST2 was 3 676 ng/L. 41 patients were assigned in the elevated sST2 group and 100 cases in the normal sST2 group. In the elevated sST2 group, the incidence of PHLF was 85%(35/41), significantly higher than 14%(14/100) in the normal sST2 group (χ2=65.31, P<0.05). The area under ROC curve of sST2 on postoperative 1 d for predicting PHLF was 0.859, the sensitivity was 0.85 and the specificity was 0.87. Multivariate Logistic regression analysis showed that extensive resection and the increase of sST2 on postoperative 1 d were the independent risk factors for PHLF (OR=16.476, 1.001; P<0.05).

Conclusions

The plasma level of sST2 is associated with PHLF, which has high predictive value for PHLF.

图1 不同PHLF分组和分级肝切除术患者围手术期sST2水平比较注:a为PHLF和非PHLF组患者sST2水平比较;b为不同PHLF分级患者sST2水平比较;*为P<0.05,***为P<0.001;pre-OP为术前,POD为术后天数,sST2为可溶性致癌性抑制基因2,PHLF为肝切除术后肝衰竭
图2 术后第1天sST2水平对肝切除术后肝衰竭的预测价值注:sST2为可溶性致癌性抑制基因2,AUC为曲线下面积
表1 PHLF影响因素的Logistic回归分析
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