摘要
目的 分析肝门部胆管癌(HCCA)患者门静脉栓塞术(PVE)术后肝脏低再生的影响因素.方法 回顾性分析2019年1月至2024年3月于河南省人民医院(郑州大学人民医院)行PVE的HCCA患者临床资料.共纳入62例患者,其中男性33例,女性29例,年龄(59.1±10.3)岁.所有患者根据PVE术后3周残肝体积再生率中位数(28.6％)分组:低再生组(n=31,残肝体积再生率＜28.6％)与高再生组(n=31,残肝体积再生率≥28.6％).比较两组区域淋巴结转移、饮酒史、肝纤维化、胆道感染占比及碱性磷酸酶、肿瘤坏死因子-α等.上述P＜0.05的变量纳入多因素logistic回归分析,分析HCCA患者PVE术后肝脏低再生的影响因素.结果 低再生组区域淋巴结转移、有饮酒史、肝纤维化、胆道感染占比及碱性磷酸酶、肿瘤坏死因子-α水平均高于高再生组,差异均有统计学意义(均P＜0.05).多因素logistic回归分析,区域淋巴结转移(OR=2.561,95％CI:1.265～5.185)、有饮酒史(OR=2.616,95％CI:1.321～5.181)、肝纤维化(OR=2.351,95％CI:1.265～4.369)、胆道感染(OR=2.461,95％CI:1.226～4.940)及碱性磷酸酶升高(OR=2.687,95％CI:1.351～5.344)、肿瘤坏死因子-α升高(OR=2.781,95％CI:1.452～5.326)的HCCA患者PVE术后肝脏低再生风险增加(均P＜0.05).结论 区域淋巴结转移、有饮酒史、肝纤维化、胆道感染及碱性磷酸酶、肿瘤坏死因子-α升高是HCCA患者PVE术后肝脏低再生的危险因素,应密切监测.
Abstract
Objective To analyze the influencing factors of low liver regeneration in patients with hilar cholangiocarcinoma(HCCA)after portal vein embolization(PVE).Method Clinical data of 62 pa-tients with HCCA undergoing PVE at Henan Provincial People's Hospital(People's Hospital of Zhengzhou University)from January 2019 to March 2024 were retrospectively analyzed,including 33 males and 29 fe-males,aged(59.1±10.3)years.Patients were divided into two groups based on the median regeneration rate of remnant liver volume(28.6％)three weeks after PVE:low regeneration(n=31,＜28.6％)and high regeneration group(n=31,≥28.6％).The proportion of lymph node metastasis,history of alcohol consumption,liver fibrosis,biliary tract infection,alkaline phosphatase(ALP),and tumor necrosis factor-α(TNF-α)were compared between two groups.Multivariate logistic regression analysis was used to indenti-fy the influencing factors of low liver regeneration in patients with HCCA after PVE surgery.Results The proportion of lymph node metastasis,history of alcohol consumption,liver fibrosis,biliary tract infection,ALP,and level of TNF-α were higher in the low regeneration group than those in the high regeneration group(all P＜0.05).Multivariate logistic regression analysis showed that patients with regional lymph node me-tastasis(OR=2.561,95％CI:1.265-5.185),history of alcohol consumption(OR=2.616,95％CI:1.321-5.181),liver fibrosis(OR=2.351,95％CI:1.265-4.369),biliary tract infection(OR=2.461,95％CI:1.226-4.940),elevated level of ALP(OR=2.687,95％CI:1.351-5.344),and ele-vated level of TNF-α(OR=2.781,95％CI:1.452-5.326)had an increased risk of low liver regeneration after PVE(all P＜0.05).Conclusion Regional lymph node metastasis,history of alcohol consumption,liver fibrosis,biliary tract infection,and elevated ALP and TNF-α are risk factors for low liver regeneration in patients with HCCA after PVE surgery,which should be noted in clinical practice.
维普
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