CTP 评分联合 RFH-NPT 评分、CONUT评分对肝硬化肝癌患者经导管肝动脉化疗栓塞术后短期预后的预测价值

作者： style="font-size: 12px ">沈兰超 吴红 李荣 陈震 张士红 张青

单位：淮安市第四人民医院 肝病科 江苏 淮安 223000

关键词：原发性肝癌 经导管肝动脉化疗栓塞术 蔡尔德 – 皮尤改良评分 医院营养 优先评估工具 控制营养状态评分 短期预后

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出版年,卷(期):页码：2026,18(1):79-86

摘要：

摘要：目的 探讨蔡尔德 – 皮尤改良评分（Child-Turcotte Pugh score，CTP score）联合 皇家自由医院营养优先评估工具（Royal Free Hospital-nutritional priorotizing tool，RFH NPT）、控制营养状态评分（controlling nutritional status，CONUT）对肝硬化肝癌患者经 导管肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）后 6 个月预后 的预测价值。方法 回顾性分析 2021 年 1 月至 2024 年 6 月淮安市第四人民医院收治的 135 例行 TACE 治疗的肝硬化肝癌患者的临床资料。收集患者 TACE 术前及术后 3 d 的 淋巴细胞计数、总胆红素（total bilirubin，TBil）、白蛋白（albumin，Alb）、血浆凝血 酶原时间（prothrombin time，PT）、总胆固醇（total cholesterol，TC）等数据，计算术 前 CTP 评分及白蛋白-胆红素评分（albumin-bilirubin score，ALBI）以评估患者肝脏功 能，根据 RFH-NPT 评分、CONUT 评分进行营养评估。按患者 TACE 术后 6 个月是否 存活分为生存组（104 例）和死亡组（31 例）。采用 Cox 比例风险回归分析患者死亡的 独立危险因素，采用受试者工作特征（receiver operator characteristic，ROC）曲线分析 CTP、RFH-NPT、CONUT 评分模型的预测能力。结果 术前 3 个月非计划的体质量下 降（HR = 1.75，95%CI：1.02～3.00，P = 0.04）、术前5 d进食减少1/2以上（HR = 3.44， 95%CI：1.41～8.36，P = 0.01）、CTP评分 ＞ 6分（HR = 3.21，95%CI：1.32～7.83，P = 0.01）、 RFH-NPT 评分 ＞ 0 分（HR = 4.84，95%CI：2.17～10.79，P ＜ 0.001）、CONUT 评分 ＞ 2 分 （HR = 3.50，95%CI：1.34～9.16，P = 0.01）是肝硬化肝癌患者 TACE 术后 6 个月死亡 的独立危险因素。CTP 评分、RFH-NPT 评分、CONUT 评分模型预测肝硬化肝癌患者 TACE 术后 6 个月死亡的 ROC 曲线下面积分别为 0.77、0.73、0.79；CTP + RFH-NPT 联合评分模型、CTP + CONUT 联合评分模型的 ROC 曲线下面积分别为 0.82、0.87， 均大于各自对应的单一 CTP、RFH-NPT、CONUT 评分模型的曲线下面积，差异有 统计学意义（P 均 ＜ 0.05）。两种联合评分模型 ROC 曲线下面积差异无统计学意义 （z = 1.10，P = 0.27）。结论 CTP、RFH-NPT、CONUT 评分是肝硬化肝癌患者 TACE 术 后 6 个月死亡的独立危险因素，CTP + RFH-NPT、CTP + CONUT 均可有效预测肝硬化 肝癌患者 TACE 术后短期死亡风险。

Abstract: Objective To investigate the predictive value of Child-Turcotte-Pugh (CTP) score combined with Royal Free Hospital-Nutritional Prioritization Tool (RFH-NPT) and controlling nutritional status (CONUT) score for the 6-month prognosis of patients with liver cirrhosis and primary liver cancer after transcatheter arterial chemoembolization (TACE). Methods A retrospective analysis was performed on the clinical data of 135 patients with liver cirrhosis and primary liver cancer who received TACE treatment in Huai’an Fourth People’s Hospital from January 2021 to June 2024. Data including lymphocyte count, total bilirubin (TBil), albumin (Alb), plasma prothrombin time (PT) and total cholesterol (TC) of the patients were collected before TACE and 3 days after surgery. Preoperative CTP score and albumin-bilirubin (ALBI) score were calculated to assess the liver function of the patients, and nutritional assessment was conducted based on RFH-NPT score and CONUT score. According to the survival status at 6 months after TACE, the patients were divided into survival group (104 cases) and death group (31 cases). Cox proportional hazards regression was used to analyze the independent risk factors for the death of the patients, and the receiver operating characteristic (ROC) curve was applied to evaluate the predictive performance of the CTP, RFH-NPT and CONUT scoring models. Results Unintentional weight loss within 3 months before surgery (HR = 1.75, 95%CI: 1.02～3.00, P = 0.04), over 50% reduction in food intake 5 days before surgery (HR = 3.44, 95%CI: 1.41～8.36, P = 0.01), CTP score ＞ 6 (HR = 3.21, 95%CI: 1.32～7.83, P = 0.01), RFH-NPT score ＞ 0 (HR = 4.84, 95%CI: 2.17～10.79, P ＜ 0.001) and CONUT score ＞ 2 (HR = 3.50, 95%CI: 1.34～9.16, P = 0.01) were independent risk factors for death in patients with liver cirrhosis and primary liver cancer 6 months after TACE. The area under the ROC curve of the CTP score, RFH NPT score and CONUT score models for predicting 6-month mortality in patients with liver cirrhosis and primary liver cancer after TACE was 0.77, 0.73 and 0.79, respectively. The areas under the ROC curve of CTP + RFH-NPT and CTP + CONUT were 0.82 and 0.87, respectively, both higher than those of the corresponding single CTP, RFH-NPT and CONUT scoring models, and the differences were statistically significant (all P ＜ 0.05). There was no statistically significant difference in the area under the ROC curve between the two combined scoring models (z = 1.10, P = 0.27). Conclusions CTP, RFH-NPT and CONUT score were independent risk factors affecting the prognosis of patients with liver cirrhosis and primary liver cancer after TACE. Both CTP + RFH-NPT and CTP + CONUT could effectively predict the short-term mortality risk of patients with liver cirrhosis and primary liver cancer after TACE.

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