摘要
目的探讨血清25羟维生素D_(3)[25(OH)D_(3)]及外周血维生素D受体(VDR)水平与晚期肝细胞癌(HCC)患者索拉非尼靶向治疗疗效及生存情况的关系。方法选择2017年4月至2019年4月沧州市传染病医院收治的105例接受索拉非尼靶向治疗的晚期HCC患者为病例组,另选择同期健康体检者40例为健康组。对比病例组、健康组相关指标水平并分析其相关性;比较不同疗效患者的资料,采用多因素Logistic回归分析疗效的影响因素,采用受试者工作特征曲线分析25(OH)D_(3)、VDR对疗效的预测价值,采用Kaplan-Meier生存曲线比较不同25(OH)D_(3)、VDR水平患者的生存情况。结果病例组25(OH)D_(3)、VDR水平低于健康组,血清白细胞介素-6(IL-6)、可溶性白细胞介素-2受体(sIL-2R)、糖类抗原125(CA125)、总胆红素(TBIL)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)水平高于健康组,差异均有统计学意义(P<0.05)。HCC患者25(OH)D_(3)、VDR水平与IL-6、sIL-2R、CA125、TBIL、ALT、AST水平均呈负相关(P<0.05);25(OH)D_(3)水平与VDR水平呈正相关(P<0.05)。经治疗,病例组患者缓解率为25.71%。完全缓解(CR)+部分缓解(PR)患者年龄小于病情稳定(SD)+疾病进展(PD)患者,血清IL-6、sIL-2R、CA125水平低于SD+PD患者,25(OH)D_(3)、VDR水平高于SD+PD患者,差异均有统计学意义(P<0.05)。25(OH)D_(3)和VDR水平降低是晚期HCC患者疗效的独立危险因素(P<0.05)。25(OH)D_(3)、VDR单项及联合预测晚期HCC疗效的曲线下面积(AUC)分别为0.840、0.705、0.866,联合预测的AUC大于VDR的AUC(P<0.05)。25(OH)D_(3)≥33.39 nmol/L、VDR≥27.26 ng/mL患者生存率高于25(OH)D_(3)<33.39 nmol/L、VDR<27.26 ng/mL患者(Log-rankχ^(2)=51.882、39.480,P<0.001)。结论25(OH)D_(3)、VDR可预测晚期HCC索拉非尼靶向治疗的疗效,25(OH)D_(3)和VDR低水平的HCC患者生存率更低。
Objective To investigate the relationship between serum 25-hydroxyvitamin D_(3)[25(OH)D_(3)]and peripheral blood vitamin D receptor(VDR)levels with the efficacy and survival of sorafenib targeted therapy in patients with advanced stage hepatocellular carcinoma(HCC).Methods A total of 105 patients with advanced stage HCC who received sorafenib targeted therapy at Cangzhou Infectious Disease Hospital from April 2017 to April 2019 were selected as the case group.Additionally,40 healthy individuals who underwent health check-ups during the same period were selected as the health group.The levels of relevant indicators both in the case group and the health group were compared and their correlations were analyzed.Data on patients with different treatment outcomes were compared.Multivariate Logistic regression analysis was used to identify factors influencing treatment efficacy.Receiver operating characteristic(ROC)curve was plotting to assess the predictive value of 25(OH)D_(3) and VDR for treatment efficacy,and Kaplan-Meier survival curve was used to compare survival outcomes of patients with different levels of 25(OH)D_(3) and VDR.Results The levels of 25(OH)D_(3) and VDR in the case group were lower than those in the health group,while serum levels of interleukin-6(IL-6),soluble interleukin-2 receptor(sIL-2R),carbohydrate antigen 125(CA125),total bilirubin(TBIL),aspartate aminotransferase(AST)and alanine Aminotransferase(ALT)were higher than those in the health group,and the differences were statistically significant(P<0.05).The levels of 25(OH)D_(3) and VDR were negatively correlated with IL-6,sIL-2R,CA125,TBIL,AST and ALT levels(P<0.05),and 25(OH)D_(3) level was positively correlated with VDR level(P<0.05).After treatment,the remission rate in the case group was 25.71%.Patients with complete response(CR)or partial response(PR)were younger than those with stable disease(SD)or progressive disease(PD),and serum levels of IL-6,sIL-2R and CA125 were lower,25(OH)D_(3) and VDR levels were higher in CR+PR patients compare
作者
李玉苓
邹东花
杨大伟
LI Yuling;ZOU Donghua;YANG Dawei(Department of Integrated Traditional and Western Medicine for Liver Diseases;Department of Clinical Laboratory,Cangzhou Infectious Disease Hospital,Cangzhou,Hebei 061000,China;Department of Surgery,Shijiazhuang Traditional Chinese Medicine Hospital,Shijiazhuang,Hebei 050000,China)
出处
《检验医学与临床》
CAS
2024年第21期3111-3116,共6页
Laboratory Medicine and Clinic
基金
河北省医学科学研究课题(20221724)
河北省沧州市科技计划项目(172302049)。
