Child-Pugh、MELD等传统评估指标局限性与SII、AFR、NPAR等新型复合指标在肝癌切除术后并发症及预后预测中的研究综述

Review on the Limitations of Traditional Assessment Indicators (Child-Pugh, MELD) and the Research of New Composite Indicators (SII, AFR, NPAR) in the Prediction of Postoperative Complications and Prognosis of Hepatocellular Carcinoma Resection

摘要: 肝癌切除术是早期原发性肝癌(Hepatocellular Carcinoma, HCC)的根治性方案，其疗效与术后并发症直接影响患者的预后。在微创技术与加速康复外科(Enhanced Recovery After Surgery, ERAS)推广下，出血、感染、肝功能衰竭等并发症仍是患者生存率下降的关键因素。临床目前常用的术后预测指标Child-Turcotte-Pugh分级(以下简称Child-Pugh分级)与终末期肝病模型(Model for End-Stage Liver Disease, MELD)，存在显著局限性：前者依赖主观分级如腹水分度，易受短期干预干扰，且对肝功能损伤及炎症–免疫失衡敏感性不足；后者算法复杂、未纳入炎症–营养指标，对Child-Pugh A级患者及非病毒性肝硬化患者评估效能欠佳。为弥补传统指标缺陷，系统免疫炎症指数(Systemic Immune-Inflammation Index, SII)、白蛋白–纤维蛋白原比率(Albumin-Fibrinogen Ratio, AFR)、中性粒细胞与淋巴细胞比率(Neutrophil-to-Lymphocyte Ratio, NLR)及血小板与淋巴细胞比率(Platelet-to-Lymphocyte Ratio, PLR)、中性粒细胞–白蛋白比率(Neutrophil-to-Albumin-Ratio, NPAR)等新型复合指标应运而生。此类指标整合炎症、免疫与营养多个维度，如SII可通过血小板、中性粒细胞及淋巴细胞计数综合反映免疫炎症状态，在肝癌患者中展现出良好的预后预测效能；AFR凭借白蛋白的稳定反映肝储备与营养与纤维蛋白原的快速响应急性炎症，具有双向互补性，能精准预警传统指标易遗漏的术后并发症风险，尤其在合并乙肝肝硬化的特殊人群中优势显著。本文综述肝癌切除术后并发症的影响因素，重点对比Child-Pugh、MELD传统指标的局限性与SII、AFR、NLR、PLR、NPAR等新型复合指标的研究进展，剖析指标背后的“炎症–免疫–营养”关联机制，并结合当前研究缺口，未来需要通过更科学的研究找到关键指标的临界值，结合多种科学的评估方法，把这些成果用于临床，让肝癌切除手术前后的预后评估更精准化与个体化。

Abstract: Liver cancer resection is a curative option for early primary liver cancer (Hepatocellular Carcinoma, HCC), and its efficacy and postoperative complications directly affect the prognosis of patients. With the promotion of minimally invasive techniques and Enhanced Recovery After Surgery (ERAS), complications such as bleeding, infection, and liver failure remain key factors in the decline of patient survival rates. The commonly used postoperative prediction indicators in clinical practice, Child-Turcotte-Pugh grading (hereinafter referred to as Child-Pugh grading) and Model for End-Stage Liver Disease (MELD), have significant limitations: the former relies on subjective grading such as ascites grading, is susceptible to short-term intervention interference, and has insufficient sensitivity to liver function damage and inflammation-immune imbalance; The latter algorithm is complex and does not include inflammation-nutrition indicators, resulting in poor evaluation performance for Child-Pugh A patients and non-viral cirrhosis patients. To compensate for the shortcomings of traditional indicators, new composite indicators such as the Systemic Immune-Inflammation Index (SII), Albumin-Fibrinogen Ratio (AFR), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Neutrophil-to-Albumin-Ratio (NPAR) have emerged. This type of indicator integrates multiple dimensions of inflammation, immunity, and nutrition. For example, SII can comprehensively reflect the immune-inflammatory status through platelet, neutrophil, and lymphocyte counts, demonstrating good prognostic predictive efficacy in liver cancer patients; AFR leverages the stability of albumin (which reflects liver reserve and nutrition) and the rapid responsiveness of fibrinogen (which reflects acute inflammation). It has two-way complementarity and can accurately predict the risk of postoperative complications that are easily missed by traditional indicators, especially in the special population with hepatitis B-related cirrhosis. This article reviews the influencing factors of postoperative complications in liver cancer resection, with a focus on comparing the limitations of traditional indicators such as Child-Turcotte-Pugh and MELD with the research progress of new composite indicators such as SII, AFR, NLR, PLR, NPAR. It analyzes the “inflammation-immune-nutrition” correlation mechanism behind the indicators, and combines current research gaps. In the future, more scientific research is needed to determine the cut-off values of key indicators, and various scientific evaluation methods should be used to apply these results to clinical practice, so as to make the prognosis evaluation before and after liver cancer resection more accurate and individualized.