术前抗病毒治疗与乙型肝炎病毒相关肝细胞癌肝切除术后肝功能衰竭发生率的关系

IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Xiao Wang, Zhao-Yi Lin, You Zhou, Qin Zhong, Zong-Ren Li, Xi-Xiang Lin, Ming-Gen Hu, Kun-Lun He
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引用次数: 0

摘要

背景 肝切除术后肝功能衰竭(PHLF)是肝细胞癌(HCC)根治性部分肝切除术的常见后果。目的 探讨术前抗病毒治疗与 PHLF 之间的关系,并评估乙型肝炎病毒 (HBV) DNA 水平在预测 PHLF 方面的潜在疗效。方法 对1301例接受根治性肝切除术的HCC患者进行了回顾性研究。采用接收者操作特征(ROC)分析评估 HBV DNA 预测 PHLF 的能力,并为后续分析确定最佳临界值。逻辑回归分析用于评估 PHLF 的独立风险因素。ROC 曲线下面积的增加、分类净重分类改进(NRI)和综合辨别改进(IDI)用于量化 HBV DNA 水平预测 PHLF 的有效性。P<0.05为差异有统计学意义。结果 逻辑回归分析显示,术前抗病毒治疗与 PHLF 风险的降低有独立相关性(P < 0.05)。最佳临界值为 269 IU/mL 的 HBV DNA 水平(P < 0.001)是 PHLF 的独立风险因素。加入 HBV DNA 水平变量后,所有参考模型的曲线下面积、分类 NRI 和 IDI 都有所改善,尤其是纤维化-4 模型,其值分别为 0.729(95%CI:0.705-0.754)、1.382(95%CI:1.341-1.423)和 0.112(95%CI:0.110-0.114)。上述结果均具有统计学意义。结论 综上所述,术前抗病毒治疗可降低 PHLF 的发生率,而术前 HBV DNA 水平的升高与 PHLF 易感性的增加存在相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of preoperative antiviral treatment with incidences of post-hepatectomy liver failure in hepatitis B virus-related hepatocellular carcinoma
BACKGROUND Post-hepatectomy liver failure (PHLF) is a common consequence of radical partial hepatectomy in hepatocellular carcinoma (HCC). AIMS To investigate the relationship between preoperative antiviral therapy and PHLF, as well as assess the potential efficacy of hepatitis B virus (HBV) DNA level in predicting PHLF. METHODS A retrospective study was performed involving 1301 HCC patients with HBV who underwent radical hepatectomy. Receiver operating characteristic (ROC) analysis was used to assess the capacity of HBV DNA to predict PHLF and establish the optimal cutoff value for subsequent analyses. Logistic regression analyses were performed to assess the independent risk factors of PHLF. The increase in the area under the ROC curve, categorical net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to quantify the efficacy of HBV DNA level for predicting PHLF. The P < 0.05 was considered statistically significant. RESULTS Logistic regression analyses showed that preoperative antiviral therapy was independently associated with a reduced risk of PHLF (P < 0.05). HBV DNA level with an optimal cutoff value of 269 IU/mL (P < 0.001) was an independent risk factor of PHLF. All the reference models by adding the variable of HBV DNA level had an improvement in area under the curve, categorical NRI, and IDI, particularly for the fibrosis-4 model, with values of 0.729 (95%CI: 0.705-0.754), 1.382 (95%CI: 1.341-1.423), and 0.112 (95%CI: 0.110-0.114), respectively. All the above findings were statistically significant. CONCLUSION In summary, preoperative antiviral treatment can reduce the incidence of PHLF, whereas an increased preoperative HBV DNA level has a correlative relationship with an increased susceptibility to PHLF.
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