摘要
目的分析甲胎蛋白(AFP)、a-L-岩藻糖苦酶(AFU)、肿瘤特异性生长因子(TSGF)及白细胞介素8(IL-8)对肝癌诊断及肝移植术预后评估的价值。方法通过移植后病理检测确定50例原发性肝癌患者为观察组,选择正常个体活体肝移植提供者50例为对照组。比较两组的血清天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)和白蛋白(ALB)浓度;比较两组AFP、AFU、TSGF、IL-8浓度;单独检测及联合检测4种标志物对诊断原发性肝癌的敏感度、特异度及准确度;另外检测观察组在术前、术后第1天、术后第7天、术后第14天、术后第28天的四种标志物浓度,并长期随访,研究和分析患者的长期预后与血清中四种标志物浓度的关系。结果观察组的ALB浓度明显低于对照组,AST、ALT、AFP、TSGF、IL-8以及血清AFU指标均高于对照组,差异有统计学意义(P<0.05);横向对比发现,AFP的特异度、准确度和阳性预测值最高,IL-8的敏感度最高,AFU的阴性预测值最高。观察组患者术后4个月、8个月、12个月的总体生存率分别为100%、95%、88%。术后4个月、8个月、12个月的肿瘤复发率分别为3%、22%、28%。AFP>500 ng/ml、AFU>700 nmol/(ml·h)、TSGF≤75(pg/ml)患者的生存率随时间推移显著降低,差异有统计学意义(P<0.05)。AFP>500 ng/ml、AFU>700 nmol/(ml·h)、IL-8>140 pg/ml患者相比于AFP≤500 ng/ml、AFU≤700nmol/(ml·h)、IL-8≤140 pg/ml患者复发率显著增高,差异有统计学意义(P<0.05)。对患者进行跟踪监测,发现在第14天时,复发组的AFP的浓度显著高于无复发组,第28天时,复发组AFP、AFU、IL-8的浓度显著高于对照组,差异有统计学意义(P<0.05)。结论 AFP、AFU、TSGF及IL-8对肝癌患者诊断有意义,但联合诊断更加准确,可以弥补AFP单独诊断的不足。以上四种标志物对肝移植患者的生存率和复发率研究有一定指导意义,值得进一步探究。
Objective To analyze and study the diagnostic and prognostic value of AFP,AFU,TSGF and IL-8 in liver transplantation patients with liver cancer. Methods 50 cases of primary liver cancer were selected as observation group determined by pathological detection after transplantation,and 50 cases of normal individuals living donor liver transplantation patients as control group. Serum AST,ALT,albumin concentrations were detected and compared; AFP,AFU,TSGF,IL-8 concentration of the two groups were compared. The sensitivity,specificity and accuracy of single detection and combined detection of four markers in the diagnosis of primary liver cancer were calculated. The concentration of the four markers were detected before the operation,the 1d,7d,14 d,28d after operation and they were long-term followed-up. The correlation of prognosis and four markers were analyzed. Results Albumin concentrations of observation group was obviously higher than that of control group,the rest of the indicators were lower than those of the control group with statistically significant difference（P〈0. 05）. Lateral comparison found that the specificity,accuracy,and the positive predictive value of AFP were highest,IL-8 had the highest sensitivity,and AFU had highest negative predictive value. The overall survival rates of 50 observation group patients after 4 months,eight months,12 months were 100%,95%and 88%,respectively. The tumor recurrence rates after 4 months,eight months,12 months were 3%,22% and 28%,respectively. The survival rate of patients with AFP 500 ng/ml,AFU 700 nmol/（ml·h） and TSGF≤75（pg/ml） decreased significantly over time（P〈0. 05）.The recurrence rate of patients with AFP 500 ng/ml,AFU 700 nmol/（ml·h）,IL-8 140 pg/ml increased significantly,compared with those with AFP≤500 ng/ml,AFU≤700 nmol/（ml·h）,IL-8≤140 pg/ml（P〈0. 05）. During the monitoring of patients,the concentration of AFP in the recurrence group was significantly higher than without recurrence group in 14 d after surgery. The
出处
《临床和实验医学杂志》
2017年第8期776-780,共5页
Journal of Clinical and Experimental Medicine
