摘要
目的探讨肝细胞癌患者血清Dickopff相关蛋白1(Dickopff-1)水平对TACE治疗后预后的影响。方法2016年1月~2018年1月在我院住院经导管动脉化疗栓塞术(TACE)治疗的HCC患者90例,选择同期在我院进行健康体检者90例,慢性乙型肝炎(CHB)患者86例,乙型肝炎肝硬化患者81例,采用ELISA法检测血清Dickopff-1和AFP水平,对HCC患者进行为期24个月的随访,绘制研究对象受试者工作特征曲线(ROC)并计算曲线下面积(AUC),确定血清Dickopff-1和AFP诊断HCC的效能,应用Kaplan-Meier曲线进行生存分析。结果HCC组血清Dickopff-1和AFP水平显著高于肝硬化组[分别为(2.4±0.2)ng/ml和(815.7±73.0)ng/ml对(0.7±0.2)ng/ml和(293.2±25.7)ng/ml,P<0.05]或CHB组【分别对(0.8±0.1)ng/ml和(12.3±3.0)ng/ml,P<0.05】或健康人【分别对(0.7±0.1)ng/ml和(11.5±2.5)ng/ml,P<0.05】;TACE治疗后HCC患者血清Dickopff-1水平降至(1.6±0.6)ng/ml(P<0.05);有癌栓的HCC患者血清Dickopff-1水平显著高于无癌栓患者[(3.0±0.3)ng/ml对(2.1±0.5)ng/ml,P<0.05];死亡患者血清Dickopff-1水平显著高于生存患者[(3.5±0.8)ng/ml对(1.2±0.3)ng/ml,P<0.05];血清Dickopff-1和AFP单独诊断HCC的AUC分别为0.860和0.618,对HCC都有一定的诊断价值(Z=6.297,P<0.05);血清Dickopff-1和AFP联合应用能提高诊断效能(AUC=0.892),其诊断的灵敏度、特异度和准确度均最高;Kaplan-Meier生存分析显示,高血清Dickopff-1水平患者总体生存率显著低于低水平组(x 2=8.418,P<0.05)。结论HCC患者血清Dickopff-1水平升高,其水平越高,在TACE治疗后预后越差,是否可以作为HCC患者在TACE治疗后疗效和预后判断的指标,值得研究。
Objective To investigate serum level of dickopff 1 in patients with hepatocellular carcinoma(HCC)and its impact on prognosis after transcatheter arterial chemoembolization(TACE)treatment.Methods 90 patients HCC,90 healthy persons,86 patients with chronic hepatitis B(CHB)and 81 patients with hepatitis B cirrhosis were enrolled in this study from January 2016 to January 2018,and all patients with HCC received TACE and followed-up for 24 months.Serum levels of Dickopff-1 and AFP were measured by ELISA.Serum Dickopff-1 levels in patients with different clinical and pathological characteristics were compared.The receiver operating characteristic curve(ROC)was drawn to determine the efficacy of serum Dickopff-1 and AFP in the diagnosis of HCC,and the Kaplan-Meier curve was applied for survival analysis.Results Serum Dickopff-1 and AFP levels in patients with HCC were significantly higher than those in patients with liver cirrhosis[(2.4±0.2)ng/ml and(815.7±73.0)ng/ml vs.(0.7±0.2)ng/ml and(293.2±25.7)ng/ml,respectively,P<0.05]or in patients with CHB[(0.8±0.1)ng/ml and(12.3±3.0)ng/ml,P<0.05]or in healthy persons[(0.7±0.1)ng/ml and(11.5±2.5)ng/ml,respectively,P<0.05];serum level of dickopff-1 in patients with HCC reduced after TACE treatment to(1.6±0.6)ng/ml,(P<0.05);serum level of dickopff-1 in HCC patients with portal cancer thrombus was higher than that in patients without[(2.9±0.3)ng/ml vs.(2.1±0.5)ng/ml,P<0.05);serum level of dickopff-1 in dead patients was higher than that in survivals[(3.5±0.8)ng/ml vs.(1.2±0.3)ng/ml,(P<0.05);the area under the ROC curve(AUC)of serum dickopff-1 or AFP alone in the diagnosis of HCC were 0.860 and 0.618,respectively,which had certain diagnostic value for HCC(Z=6.297,P<0.05)and the combined diagnosis of dickopff-1 and AFP improved the efficacy(AUC=0.892),and the sensitivity,specificity and accuracy of the diagnosis were all the highest;the Kaplan-Meier survival analysis showed that the overall survival of patients with high serum dickopff-1 levels was poorer than that in p
作者
鲁斌
程敏
Lu Bin;Cheng Min(Department of Hepatobiliary Surgery,Chaohu Hospital Affiliated to Anhui Medical University,Chaohu 238000,Anhui Province,China)
出处
《实用肝脏病杂志》
CAS
2020年第5期719-722,共4页
Journal of Practical Hepatology
基金
安徽省自然科学基金资助项目(编号:1508085MH173)。
