中晚期肝癌患者肝动脉化疗栓塞术后肝功能代偿不全影响因素分析
|
摘要
目的:分析中晚期原发性肝癌(HCC)首次行肝动脉化疗栓塞术(TACE)后出现肝功能代偿不全的影响因素。方法:回顾性分析103例中晚期HCC首次行TACE术患者的临床资料,根据其术后是否发生肝功能代偿不全分为2组,对2组患者术前、术后相关临床数据进行单因素与多因素分析,找出影响患者术后出现肝功能代偿不全的主要因素。结果:单因素分析显示,术前患者吸烟、年龄、门脉Ⅱ级主干癌栓、乙肝、凝血酶原时间、D-二聚体、谷氨酰转肽酶(GGT)水平、肿瘤大小均是首次TACE术后出现肝功能代偿不全的影响因素(均P<0.05);多因素logistic回归分析显示,年龄、血凝血酶原时间、D-二聚体、GGT、肿瘤大小是首次TACE术后出现肝功能代偿不全的危险因素(均P<0.05)。结论:高龄、肿瘤较大、凝血酶原时间、D-二聚体、GGT升高的中晚期HCC患者行TACE术后出现肝功能代偿不全的风险高。
Objective: To analyze the influencing factors of compensatory insufficiency of liver function in patients with advanced primary hepatocellular carcinoma(HCC) for the first time after transcatheter arterial chemoembolization(TACE). Methods: A total of 103 patients with primary advanced HCC who underwent TACE for treatment were reviewed, and divided into two arms according to whether insufficiency of liver function was developed after TACE. Univariate and multivariate analyses were performed on the clinical data before and after TACE to screen the main factors influencing postoperative insufficiency of liver function. Results: Univariate analysis showed that smoking, age, main portal vein(Tpye Ⅱ) tumor thrombus, hepatitis B infection status, prothrombin time, D-dimer, GGT level and main tumor size before TACE were the influencing factors of compensatory insufficiency of liver function after the first time of TACE(P<0.05). Multivariate logistic regression analysis showed that age, prothrombin time, D-dimer and GGT and tumor size were the influencing factors of compensatory insufficiency of liver function after the first time of TACE(P<0.05). Conclusion: Advanced age, larger tumor size, prothrombin time, D-dimer and elevated GGT increased the risk of compensatory insufficiency of liver function in patients with advanced HCC after TACE.
Objective: To analyze the influencing factors of compensatory insufficiency of liver function in patients with advanced primary hepatocellular carcinoma(HCC) for the first time after transcatheter arterial chemoembolization(TACE). Methods: A total of 103 patients with primary advanced HCC who underwent TACE for treatment were reviewed, and divided into two arms according to whether insufficiency of liver function was developed after TACE. Univariate and multivariate analyses were performed on the clinical data before and after TACE to screen the main factors influencing postoperative insufficiency of liver function. Results: Univariate analysis showed that smoking, age, main portal vein(Tpye Ⅱ) tumor thrombus, hepatitis B infection status, prothrombin time, D-dimer, GGT level and main tumor size before TACE were the influencing factors of compensatory insufficiency of liver function after the first time of TACE(P<0.05). Multivariate logistic regression analysis showed that age, prothrombin time, D-dimer and GGT and tumor size were the influencing factors of compensatory insufficiency of liver function after the first time of TACE(P<0.05). Conclusion: Advanced age, larger tumor size, prothrombin time, D-dimer and elevated GGT increased the risk of compensatory insufficiency of liver function in patients with advanced HCC after TACE.
引文
1 崔艳峰,徐浩,李国均,魏宁.肝细胞癌TACE术后严重并发症分析[J].中国介入影像与治疗学.2005,2(1): 31-33.
2 中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)摘要[J].中华肝脏病杂志,2012,20(6): 419-426.
3 Lo CM,Ngan H,Tso WK,et al.Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma[J].Hepatology,2002.35(5):1164-1171.
4 Savastano S,Miotto D,Casarrubea G,et al.Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with Child's grade A or B cirrhosis: a multivariate analysis of prognostic factors[J].J Clin Gastroenterol,1999,28(4): 334-340.
5 周霖,王华明,艾鼎伦等.原发性肝癌患者肝动脉化疗栓塞术后肝功能失代偿的临床分析[J].解放军医学杂志,2014.39(2): 149-153.
6 Guiu B,Deschamps F,Boulin M,et al.Serum gamma-glutamyl-transferase independently predicts outcome after transarterial chemoembolization of hepatocellular carcinoma: external validation[J].Cardiovasc Intervent Radiol,2012.35(5): 1102-1108.
7 元淑巧,杨银芳,胥敏敏,等.血浆D-二聚体及纤维蛋白(原)降解产物检测的临床意义.解放军医学院学报.2014.35(9): 896-898.
8 Zhang X,Liu ZQ,Zhang W,et al.A retrospective analysis of plasma D-dimer dynamic variation in terminal stage cancer patients: implications for disease progression[J].Int J Clin Exp Med,2014.7(8): 2395-2401.
9 Sakurai M,Satoh T,Matsumoto K,et al.High Pretreatment Plasma D-dimer Levels are associated with poor prognosis in patients with ovarian cancer independently of venous thromboembolism and tumor extension[J].Int J Gynecol Cancer,2015.25(4): 593-598.
2 中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)摘要[J].中华肝脏病杂志,2012,20(6): 419-426.
3 Lo CM,Ngan H,Tso WK,et al.Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma[J].Hepatology,2002.35(5):1164-1171.
4 Savastano S,Miotto D,Casarrubea G,et al.Transcatheter arterial chemoembolization for hepatocellular carcinoma in patients with Child's grade A or B cirrhosis: a multivariate analysis of prognostic factors[J].J Clin Gastroenterol,1999,28(4): 334-340.
5 周霖,王华明,艾鼎伦等.原发性肝癌患者肝动脉化疗栓塞术后肝功能失代偿的临床分析[J].解放军医学杂志,2014.39(2): 149-153.
6 Guiu B,Deschamps F,Boulin M,et al.Serum gamma-glutamyl-transferase independently predicts outcome after transarterial chemoembolization of hepatocellular carcinoma: external validation[J].Cardiovasc Intervent Radiol,2012.35(5): 1102-1108.
7 元淑巧,杨银芳,胥敏敏,等.血浆D-二聚体及纤维蛋白(原)降解产物检测的临床意义.解放军医学院学报.2014.35(9): 896-898.
8 Zhang X,Liu ZQ,Zhang W,et al.A retrospective analysis of plasma D-dimer dynamic variation in terminal stage cancer patients: implications for disease progression[J].Int J Clin Exp Med,2014.7(8): 2395-2401.
9 Sakurai M,Satoh T,Matsumoto K,et al.High Pretreatment Plasma D-dimer Levels are associated with poor prognosis in patients with ovarian cancer independently of venous thromboembolism and tumor extension[J].Int J Gynecol Cancer,2015.25(4): 593-598.