原发性肝癌患者TACE前后血清GP73动态变化1

摘要

目的评价行肝动脉栓塞化疗术（TACE）的原发性肝癌患者手术前后血清高尔基体蛋白73（GP73）的动态变化及其临床意义；探讨肝癌患者血清GP73与肝功能等指标的相关性，从而找出判断肝癌患者TACE疗效及预后的新血清学标志物。方法应用酶联免疫吸附测定法（ELISA）检测50例行TACE治疗原发性肝癌患者手术前后的血清GP73水平，根据TNM分期、肝脏影像学、甲胎蛋白（AFP）、Child-Pugh分级、PS评分综合评估，将患者分为好转组（23例）和恶化组（27例），观察血清GP73的动态变化与临床转归的关系，并对患者术前血清GP73与肝功能各项指标进行相关性分析，对可能影响GP73水平的临床特征资料进行分析。结果好转组术后1周血清GP73水平较术前明显升高（F =19.47，P ＜0.0001），术后1～3个月血清GP73较术后1周下降（F =32.54，P ＜0.0001），且低于术前水平（P =0.0454）。恶化组术后1周及术后1～3个月血清GP73较术前均升高（F =36.71、37.2，P均＜0.0001），术后1～3个月血清GP73与术后1周无明显变化（P =0.9111）。好转组术前及术后1周血清GP73分别与恶化组比较，均无显著差异（P =0.9693、0.6894）；好转组术后1～3个月血清GP73水平较恶化组明显下降（P =0.0037）。两组患者术前血清GP73浓度与AFP水平均无相关性；而与白蛋白（ALB）水平呈负相关，与总胆红素（TBil）、谷氨酰转肽酶（GGT）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）水平呈正相关；血清GP73水平与是否有淋巴结肿大、是否存在腹水相关（P均＜0.05）。结论血清GP73可以作为监测TACE治疗效果的有效指标，血清GP73可以反映肝癌患者肝功能状态。%Objective To evaluate the clinical significance of serum GP73 of primary liver cancer patients by observing its dynamic changes and to discuss the relationship between serum GP73 and indexes of the patients’ liver function, and to find out the new serological markers which could estimate the prognosis and conventional curative effect of liver cancer patients after transcatheter arterial chemoembolization (TACE). Methods ELISA method was applied to detect preoperative and postoperative GP73 levels of 50 cases with primary liver cancer patients treated by TACE. We comprehensively evaluated the patients based on TNM staging, liver imaging, AFP, Child-Pugh grading and PS (performance status) score, and then the patients were divided into worse group (27 cases) and improved group (23 cases). The relationship between dynamic changes of their serum GP73 levels and clinical outcomes was observed. The preoperative serum GP73 levels of the 50 patients with liver cancer and the indicators of their liver functions were observed, and the correlation analysis was carried out. Clinical features that may affect the GP73 levels were analyzed. Results The serum GP73 level of improved group increased obviously one week after the operation (F = 19.47, P < 0.0001). One to three months after the operation, the GP73 level decreased compared with that one week after the operation (F = 32.54, P < 0.0001) and was lower than the preoperative level (P = 0.0454). The serum GP73 level of worse group at one week (F = 36.7, P < 0.0001) and one to three months (F = 37.2, P < 0.0001) after the operation both increased, and there was no significant change between the serum GP73 level at one to three months and one week after the operation. Comparison between improved and worse group exhibited that there were no statistical differences in serum GP73 level before and one week after the operation. The serum GP73 level of improved group decreased obviously (P < 0.01) compared to the worse group one week after operation. The serum GP73 was irrelevant to AFP but was negatively correlated with ALB in 50 patients before operation. There were positive correlationships between serum GP73 and TBil, GGT, AST, ALT, respectively. The serum GP73 was related to lymph node enlargement and ascites with P being lower than 0.05. Conclusions The serum GP73 could be taken as an effective indicator monitoring the TACE therapeutic effect. It can also reflect the condition of liver function in patients with liver cancer.