Short-term reductions in non-protein respiratory quotient and prealbumin can be associated with the long-term deterioration of liver function after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma
Short-term reductions in non-protein respiratory quotient and prealbumin can be associated with the long-term deterioration of liver function after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma
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DOI：
10.1007/s00535-012-0535-x
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发表时间：
2012-06-01
影响因子：
6.3
通讯作者：
Azuma, Takeshi
中科院分区：
文献类型：
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作者：
Saito, Masaya;Seo, Yasushi;Azuma, Takeshi
经导管动脉化疗栓塞（TACE）是治疗肝细胞癌（HCC）的有效方法。我们的目的是建立TACE术后长期肝功能障碍的早期预测模型。我们进行了一项前瞻性队列研究，纳入了109名在神户大学医院接受TACE治疗的HCC患者。术前和术后7 d分别行间接量热和血液生化检查。在TACE前和TACE后3个月评估患儿的肝功能评分。比较Child评分恶化与未Child评分恶化患者，并对Child评分恶化的独立危险因素进行统计学检验。采用多变量logistic回归建立TACE后儿童评分恶化的早期预测模型。多因素分析显示，非蛋白呼吸商（npRQ）和前白蛋白（preAlb）比值（TACE后/前7天）是儿童评分恶化的独立决定因素（p分别= 0.039和0.020）。npRQ和preAlb比值的降低与TACE术后3个月儿童评分的升高有显著相关（p分别为0.007和0.002）。建立儿童评分恶化的预测模型：exp(-6.383 × npRQ比- 3.038 × preAlb比+ 7.755)/（1 + exp(-6.383 × npRQ比- 3.038 × preAlb比+ 7.755)）。该模型对Child评分有无恶化的患者具有较好的区分能力（受试者工作曲线下面积[ROC]； AUC[0.713]； 95%可信区间[CI] 0.613-0.812）。Child评分的最佳分界点为0.449，模型的敏感性为57.1，特异性为79.1%。TACE后7天npRQ和preAlb的减少与肝功能的长期恶化有关。通过我们的模型，我们能够识别出高危患者。
Transcatheter arterial chemoembolization (TACE) is an effective treatment for hepatocellular carcinoma (HCC) that can cause deterioration of liver function. We aimed to make an early predictive model of long-term liver dysfunction after TACE.We performed a prospective cohort study involving 109 HCC patients who underwent TACE at Kobe University Hospital. Indirect calorimetry and blood biochemical examinations were performed before and 7 days after TACE. As an indicator of liver function, the Child's score was evaluated before and 3 months after TACE. Patients with and without Child's score deterioration were compared, and the independent risk factors for Child's score deterioration were statistically examined. An early predictive model of Child's score deterioration after TACE was developed using multivariate logistic regression.Multivariate analyses showed that the non-protein respiratory quotient (npRQ) and prealbumin (preAlb) ratios (7 days after/before TACE) were independent determinants of Child's score deterioration (p = 0.039 and 0.020, respectively). Decreases of the npRQ and preAlb ratios were significantly related to increases of Child's score 3 months after TACE (p = 0.007 and 0.002, respectively). The following predictive model of Child's score deterioration was developed: exp(-6.383 x npRQ ratio - 3.038 x preAlb ratio + 7.755)/(1 + exp(-6.383 x npRQ ratio - 3.038 x preAlb ratio + 7.755)). The model discriminated well between patients with and without Child's score deterioration (area under the receiver operating curve [ROC]; AUC 0.713; 95% confidence interval [CI] 0.613-0.812). The optimal cut-off point for the Child's score was 0.449, and the sensitivity and specificity of the model were 57.1 and 79.1%, respectively.Reductions in npRQ and preAlb 7 days after TACE were associated with the long-term deterioration of liver function. With our model, we were able to identify high-risk patients.