Pre-hepatectomy type IV collagen 7S predicts post-hepatectomy liver failure and recovery
Pre-hepatectomy type IV collagen 7S predicts post-hepatectomy liver failure and recovery
复制标题
DOI：
10.3748/wjg.v26.i7.725
复制
发表时间：
2020-02-21
影响因子：
4.3
通讯作者：
Kitagawa, Yuko
中科院分区：
文献类型：
--
作者：
Ishii, Masatsugu;Itano, Osamu;Kitagawa, Yuko
背景：肝切除术是治疗肝良恶性肿瘤的有效方法。然而，术前评估肝储备的方法尚未建立。先前报道的术前肝储备评估只关注术后早期的肝功能衰竭，没有考虑肝储备的长期恢复。在确定肝切除术的资格时，需要考虑潜在的病理生理学，以确定功能性肝储备是否能够承受手术和任何术后治疗。目的探讨肝切除术前因素与术后早期肝功能衰竭及术后长期肝功能恢复的关系。方法本研究为回顾性队列研究。我们回顾性调查了2013年5月至2016年12月在我院接受肝切除术的215例患者。肝切除术后早期肝衰竭（PHLF）的定义采用国际肝脏外科研究小组对PHLF的定义。术后长期肝功能恢复定义为血清总胆红素和白蛋白水平分别恢复到< 2 mg/dL和> 2.8 g/dL所需的时间，Child-Pugh评分恢复到Child-Pugh a级所需的时间。结果术前IV型胶原7S是影响PHLF和术后长期肝功能恢复的重要独立因素。进一步分析显示，IV型胶原蛋白7s6 ng/mL的患者Child-Pugh评分和血清总胆红素和白蛋白水平恢复所需的时间明显更短。在其他分析中，在没有慢性病毒性肝炎相关纤维化的患者中观察到类似的结果。结论IV型胶原7S是术前PHLF及术后长期肝功能恢复的预测因子。也可用于无慢性肝炎病毒的患者。
BACKGROUNDLiver resection is an effective treatment for benign and malignant liver tumors. However, a method for preoperative evaluation of hepatic reserve has not yet been established. Previously reported assessments of preoperative hepatic reserve focused only on liver failure in the early postoperative period and did not consider the long-term recovery of hepatic reserve. When determining eligibility for hepatectomy, the underlying pathophysiology needs to be considered to determine if the functional hepatic reserve can withstand both surgery and any postoperative therapy.AIMTo identify pre-hepatectomy factors associated with both early postoperative liver failure and long-term postoperative liver function recovery.METHODSThis study was a retrospective cohort study. We retrospectively investigated 215 patients who underwent hepatectomy at our hospital between May 2013 and December 2016. Early post-hepatectomy liver failure (PHLF) was defined using the International Study Group of Liver Surgery's definition of PHLF. Long-term postoperative recovery of liver function was defined as the time taken for serum total bilirubin and albumin levels to return to levels of < 2 mg/dL and > 2.8 g/dL, respectively, and the time taken for Child-Pugh score to return to Child-Pugh class A.RESULTSPreoperative type IV collagen 7S was identified as a significant independent factor associated with both PHLF and postoperative long-term recovery of liver function. Further analysis revealed that the time taken for the recovery of Child-Pugh scores and serum total bilirubin and albumin levels was significantly shorter in patients with type IV collagen 7S 6 ng/mL. In additional analyses, similar results were observed in patients without chronic viral hepatitis associated with fibrosis.CONCLUSIONPreoperative type IV collagen 7S is a preoperative predictor of PHLF and long-term postoperative liver function recovery. It can also be used in patients without chronic hepatitis virus.