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摘要：
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摘要：目的 研究天门冬氨酸氨基转移酶与血小板比值（aspartate aminotransferase to platelet ratio
index，APRI）对肝动脉栓塞联合射频消融治疗乙型肝炎病毒（hepatitis B virus，HBV）相关肝细胞癌
（hepatocellular carcinoma，HCC）患者预后的评估价值。方法 选取2008年1月至2010年12月在首都医
科大学附属北京佑安医院接受肝动脉栓塞联合射频消融治疗的201例HBV相关HCC患者为研究对象。
收集患者基线临床资料，包括性别、年龄、病史、基础肝病、白细胞（white blood cell，WBC）、血
小板（blood platelet，PLT）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基
转移酶（aspartate aminotransferase，AST）、白蛋白（albumin，ALB）、总胆红素（total bilirubin，
TBil）、胆碱酯酶（cholinesterase，CHE）、凝血酶原时间（prothrombin time，PT）、甲胎蛋白（alpha
fetoprotein，AFP）、Child-Pugh分级、肿瘤数目、肿瘤最大直径、肿瘤部位及腹水。计算各患者APRI
值，采用受试者工作特征（receiver operator characteristic，ROC）曲线确定基线APRI的临界值，并将
患者分为低APRI组（APRI ≤临界值）及高APRI组（APRI ＞ 临界值）。采用Kaplan-Meier法进行单因
素生存分析，绘制生存曲线，采用Log-rank检验比较组间差异，采用Cox多因素回归分析影响HBV相关
HCC患者肝动脉栓塞联合射频消融治疗总生存率的独立危险因素。结果 根据ROC曲线确定基线APRI
临界值为1.30。低APRI组104例，高APRI组97例，低APRI组与高APRI组患者间肝硬化（无/有：62/41
vs 42/56）、WBC计数（＜ 4 × 10 9 /L /≥4 × 10 9 /L：29/74 vs 55/43）、ALT（＜45 U/L / ≥ 45 U/L：82/21
vs 63/35）、ALB（＜ 35 g/L / ≥ 35 g/L：24/79 vs 49/49）、TBil（≤ 21 μmol/L / ＞ 21 μmol/L：73/30
vs 40/58）、PT（≤ 12.8 s / ＞ 12.8 s：79/24 vs 46/52）、CHE（＜ 4000 U/L / ≥ 4000 U/L：16/87 vs
43/55）、腹水（有/无：4/99 vs 15/83）及Child-Pugh分级（A级/B级：91/12 vs 70/28）的差异有统计
学意义（P均＜ 0.05）。低APRI组患者生存率显著高于高APRI组，差异有统计学意义（χ 2 = 27.84，
P ＜ 0.001）。Cox多因素预后分析表明基线APRI ＞ 1.30、ALB ＜ 35 g/L、肿瘤最大直径＞ 3 cm是影
响HBV相关HCC患者肝动脉栓塞联合射频消融治疗后生存率的独立危险因素（HR = 2.836，95% CI：
1.082～4.465，P ＜ 0.001；HR = 0.616，95% CI：0.403～0.942，P = 0.025；HR = 2.286，95% CI：
1.467～3.560，P ＜ 0.001）。结论 基线APRI、ALB水平及肿瘤最大直径是HBV相关HCC患者接受肝
动脉栓塞联合射频消融术后预后的独立预测因素。
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Abstract: Objective To investigate the prognostic value of aspartate aminotransferase to platelet ratio
index (APRI) on patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in
treatment of transcatheter arterial embolization combined with radiofrequency ablation. Methods Total of
201 patients diagnosed as HBV-related HCC and treated by transcatheter arterial embolization combined
with radiofrequency ablation in Beijing YouAn Hospital, Capital Medical University from January 2008
to December 2010 were selected. The baseline clinical data of all patients were collected, including
gender, age, medical history, background liver disease, white blood cell (WBC), blood platelet (PLT),
alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), total bilirubin (TBil),
cholinesterase (CHE), prothrombin time (PT), alpha fetoprotein (AFP), Child-Pugh grade, tumor number, the
largest tumor diameter, tumor site and ascites were collected. The baseline APRI value were calculated and
the cut-off value were determined by receiver operator characteristic (ROC) curve. The patients were divided
into low APRI group (APRI ≤ cut-off value) and high APRI group (APRI ＞ cut-off value). Survival analysis
was performed by Kaplan-Meier method, the differences were compared by Log-rank test. The effects on
multivariate of patients with HBV-related HCC in treatment of transcatheter arterial embolization combined
with radiofrequency ablation were analyzed by Cox regression analysis. Results The cut off value of APRI
was determined to be 1.30 according to ROC curve. There were 104 cases in low APRI group and 97 cases
in high APRI group. The liver cirrhosis (without/with: 62/41 vs 42/56), WBC (＜ 4 × 10 9 /L / ≥ 4 × 10 9 /L: 29/74
vs 55/43), ALT (＜ 45 U/L / ≥ 45 U/L: 82/21 vs 63/35), ALB (＜ 35 g/L / ≥ 35 g/L: 24/79 vs 49/49), TBil (≤
21 μmol/L / ＞ 21 μmol/L: 73/30 vs 40/58), PT (≤ 12.8 s / ＞ 12.8 s: 79/24 vs 46/52), CHE (＜ 4000 U/L / ≥
4000 U/L, 16/87 vs 43/55）, ascites (with/without: 4/99 vs 15/83), Child-Pugh grade (A/B: 91/12 vs 70/28)
of patients in low APRI group and high APRI group were statistically significant (all P ＜ 0.05). The survival
rate of patients in low APRI group was significantly higher than that in high APRI group (χ 2 = 27.84, P ＜ 0.001).
Cox multivariate prognostic analysis showed that baseline APRI ＞ 1.30, ALB ＜ 35 g/L and the largest tumor
diameter ＞ 3 cm were independent risk factors for the survival of patients with HBV-related HCC in treatment
of transcatheter arterial embolization combined with radiofrequency ablation (HR = 2.836, 95% CI: 1.082～4.465,
P ＜ 0.001; HR = 0.616, 95% CI: 0.403～0.942, P = 0.025; HR = 2.286, 95% CI: 1.467～3.560, P ＜ 0.001).
Conclusions Baseline APRI, ALB and the largest tumor diameter are independent factors affecting the overall
survival of patients with HBV-related HCC in treatment of transcatheter arterial embolization combined
radiofrequency ablation.
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