Liver Stiffness Assessed by Shear Wave Elastography Predicts Postoperative Liver Failure in Patients with Hepatocellular Carcinoma
Liver Stiffness Assessed by Shear Wave Elastography Predicts Postoperative Liver Failure in Patients with Hepatocellular Carcinoma
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通过剪切波弹性成像评估肝硬度可预测肝细胞癌患者术后肝功能衰竭
DOI：
10.1007/s11605-017-3443-9
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发表时间：
2017-09-01
影响因子：
3.2
通讯作者：
Sun, Hui-Chuan
中科院分区：
文献类型：
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作者：
Shen, Yinghao;Zhou, Chenhao;Sun, Hui-Chuan
肝硬化会增加患者发生术后肝功能衰竭（PLF）的风险。通过二维剪切波弹性成像（SWE）评估的肝硬度（LS）指示肝纤维化具有高准确性。LS在预测PLF方面是否上级门脉高压症（PHT）仍有待研究。该研究纳入了280例2015年7月至2016年7月因肝细胞癌接受肝切除术的患者。所有患者术前均接受LS、PHT和肝纤维化血清标志物的评估以及其他临床病理学检查。对A级和B级（或更高）PLF的危险因素进行单因素和多因素分析以及受试者工作特征曲线分析。LS预测肝硬化的临界值为10.1kPa。多变量分析确定LS、透明质酸、IV型胶原和脾肿大是PLF的独立预测因子。LS预测PLF和B级（或更高）PLF的截止值分别为11.75和11.9 kPa。LS预测PLF或大于B级PLF的准确性上级PHT（0.72 vs.0.60，0.76 vs.0.59，P < 0.05），SWE测量的LS预测PLF的准确性高于PHT。
Cirrhosis increases a patient's risk of developing postoperative liver failure (PLF). Liver stiffness (LS), assessed by two-dimensional shear wave elastography (SWE), indicates liver fibrosis with high accuracy. Whether LS is superior to portal hypertension (PHT) in predicting PLF remains to be studied.The study enrolled 280 patients who underwent hepatectomy for hepatocellular carcinoma from July 2015 to July 2016. All patients received preoperative assessments for LS, PHT, and serum markers of liver fibrosis in addition to other clinicopathological tests. Risk factors for grade A and grade B (or greater) PLF were subjected to univariate and multivariate analysis and receiver operating characteristic curve analysis.Fifty-five patients (19.6%) experienced PLF. The cutoff value of LS for predicting cirrhosis was 10.1 kPa. Multivariate analysis identified LS, hyaluronic acid, IV collagen, and the presence of splenomegaly as independent predictors of PLF. The cutoff value of LS for predicting PLF and grade B (or greater) PLF was 11.75 and 11.9 kPa, respectively. LS was superior to PHT in predicting PLF or greater than grade B PLF (0.72 vs. 0.60, 0.76 vs. 0.59, P < 0.05).LS measured by SWE can predict risk of PLF with greater accuracy than PHT.