术前全身炎症综合指数联合MELD评分对肝棘球蚴病手术患者远期预后的评估价值OA

Objective To explore the value of preoperative aggregate index of systemic inflammation(AISI)combined with Model for End-Stage Liver Disease(MELD)score in evaluating the long-term prognosis of patients with hepatic echinococcosis undergoing surgery.Methods A total of 160 patients undergoing surgery for hepatic echinococcosis admitted to the Ganzi Tibetan Autonomous Prefecture People's Hospital between February 2016 and February 2021 were enrolled.ROC curves were used to evaluate the predictive value of preoperative AISI and Model for End-Stage Liver Disease(MELD)score for long-term postoperative prognosis.According to cut-off values,patients were divided into low-AISI group(AISI<764.37,n=91)and high-AISI group(AISI≥764.37,n=69),as well as low-MELD group(MELD<9.72,n=102)and high-MELD group(MELD≥9.72,n=58).Univariate and multivariate stepwise Cox proportional hazards regression analyses were performed to identify prognostic factors,and Kaplan-Meier survival curves were applied for survival analysis.Results ROC curve analysis demonstrated that the AUC of preoperative AISI and MELD score for predicting long-term prognosis in patients undergoing hepatic echinococcosis surgery were 0.879 and 0.765,respectively,while the AUC of their combined prediction reached 0.905.The predictive efficacy of combined detection was superior to that of either index alone(P<0.05).Patients in the high-AISI group had multiple lesions,a higher proportion of Child-Pugh grade B cases,a higher incidence of hepatic hilum invasion and a larger maximum lesion diameter compared with the low-AISI group(P<0.05).Similarly,the high-MELD group had multiple lesions,more Child-Pugh grade B cases,a higher hepatic hilum invasion rate and a larger maximum lesion diameter than the low-MELD group(P<0.05).Multivariate stepwise Cox proportional hazards regression indicated that Child-Pugh grade B,hepatic hilum invasion,elevated AISI and elevated MELD score were independent adverse prognostic factors(HR=2.264,95%CI:1.548-3.311,P<0.001;HR=2.732,95%CI:1.807-4.131,P<0.001;HR=2.547,95%CI:1.711-3.792,P<0.001;HR=2.408,95%CI:1.631～3.557,P<0.001).Regular postoperative medication was an independent protective factor for long-term prognosis(HR=0.486,95%CI:0.345-0.685,P<0.001).Conclusion Preoperative AISI and MELD score have good predictive value for the long-term prognosis of patients with hepatic echinococcosis undergoing surgery,and the combined application of the two can further improve the predictive efficacy.