Multivariate Analysis And Clinical Significance Of Preliminary Study Of Elevated CHI3L1 Content After Hepatectomy For Primary Liver Cancer

Objective:1.to explore the clinical factors that lead to the increase of chitinase 3-like protein 1(CHI3L1)content after hepatectomy for primary liver cancer.2.To explore the correlation and clinical significance of postoperative CHI3L1 elevation and hepatic insufficiency.Methods: In this study,the clinical data of patients who underwent partial hepatectomy for primary liver cancer in Hunan Provincial People’s Hospital from January 1,2019 to January 1,2020 were collected by retrospective study,including the content of CHI3L1,serological indexes related to liver function,operation records,and five days after operation.According to the patient’s liver function about 7 days after operation,combined with the judgment principle of liver insufficiency in this study,the subjects were divided into liver insufficiency group(A group)and normal liver function group(B group).To explore the clinical factors of CH3L1 elevation after hepatectomy for primary liver cancer,and the correlation between CH3L1 content stratification and hepatic insufficiency,so as to provide a new evaluation idea for exploring the clinical efficacy of primary liver cancer after hepatectomy.Result:Combined with the diagnostic criteria of liver insufficiency proposed by ISGLS in 2011,82 subjects had normal liver function before operation;65 patients had liver function grade A,17 patients had grade B,and 0 patients had grade C according to Child-Pugh score before operation.The average Child score was 6.77.Five days after hepatectomy,there were 28 patients with liver function grade A,49 patients with grade B and 5 patients with grade C according to Child-Pugh score.The average Child score was 8.05 on the 5th day after hepatectomy.On the seventh day after hepatectomy,25 cases developed postoperative liver insufficiency,57 patients recovered well after hepatectomy,and the probability of liver insufficiency after hepatectomy was about 30.5%.The median content of CHI3L1 was 121.95ng/ml before admission and240.53ng/ml 5 days after operation.By comparing the levels of CHI3L1 before and after operation in the liver function insufficiency group(Group A)and the liver function normal group(Group B),it can be concluded that the level of CHI3L1 in patients with primary liver cancer after hepatectomy is significantly increased,with a statistically significant difference(P < 0.05).The comparison of CHI3L1 content between group A and group B,and the difference is significant(p < 0.01 in group a and p < 0.05 in group b),indicating that the content of CHI3L1 in group a is higher than that in group B before and after operation.Then,in order to explore the clinical factors and causes of CHI3L1 elevation after hepatectomy for primary liver cancer,the clinical factors such as gender,age,surgical method,hepatectomy volume ≥3segments,blocking the first hepatic portal,ascites,cirrhosis,INR,inflammation,total bilirubin,albumin,ALT and AST were analyzed by Chi-square or Fisher accurate test,and the hepatectomy volume ≥3 segments was selected.Therefore,the above four clinical factors were included in the analysis of binary Logistic regression equation for further demonstration,and it was concluded that inflammation(P=0.043),blocking hepatic portal(P=0.021),hepatectomy ≥3 segments(P=0.032)and liver cirrhosis(P=0.010)were all independent clinical factors leading to the increase of CHI3L1 after hepatectomy for primary liver cancer.After hepatectomy,the difference of CHI3L1 content in primary liver cancer was AUC=0.774,Youden index =0.5648,and the critical value was 189.81ng/ml.At this time,the specificity was 84.75,the sensitivity was 71.75,and the p value was less than 0.001,with statistical significance.The difference between postoperative and preoperative CHI3L1 was stratified,with 189.81ng/ml as the limit.There were 38 cases with less than 189.81ng/ml,among which 7 cases had hepatic insufficiency,accounting for about 18.42%.There were 20 cases with ≥189.81ng/ml and < 300ng/ml,among which 6 cases had hepatic insufficiency,accounting for about 30%.15 cases were ≥300ng/ml but < 400,among which 6 cases had hepatic insufficiency,accounting for about 40%.There were 9 cases ≥400ng/ml,among which 6 cases had hepatic insufficiency,accounting for 66.67%.The X~2/t value is 10.865,the P value is equal to 0.012,P < 0.05,the difference is significant and has statistical significance.Therefore,We speculate that with the increase of the difference between postoperative CHI3L1 and preoperative CHI3L1,the risk of liver insufficiency is greater,but more in-depth research is still needed.Conclusion1.The increase of CHI3L1 content after hepatectomy for primary liver cancer is mainly due to the comprehensive effects of clinical factors such as hepatectomy volume ≥ 3 segments,blockage of hepatic blood flow,inflammation and liver cirrhosis.2.The elevated level of CHI3L1 after hepatectomy can better reflect the occurrence of postoperative liver insufficiency,and the rate of liver insufficiency varies with different levels of CHI3L1.The higher the level of CHI3L1 after hepatectomy,the greater the risk of liver insufficiency.We speculate that with the increase of the difference between postoperative CHI3L1 and preoperative CHI3L1,the risk of liver insufficiency is greater,but more in-depth research is still needed.