冷冻消融与微波消融治疗对肝细胞癌患者临床指标和细胞因子的影响

目的 探讨冷冻消融和微波消融治疗前后肝细胞癌(HCC)患者外周血临床指标和细胞因子的变化及临床意义。方法 收集2018年6月-12月于解放军总医院第五医学中心治疗的62例HCC患者的临床资料,按照治疗方案分为:冷冻消融治疗组( n=30)和微波消融治疗组(n =32)。分别测定两组患者手术前1周及手术后2 d的血常规(WBC、Hb、PLT)、肝功能(ALT、AST、TBil、ALb)、凝血功能(INR)和外周血细胞因子[IL-2、TNFα、IL-6、IL-8、肝细胞生长因子(HGF)、血管内皮生长因子(VEGF)A]。计数资料组间比较采用χ 2 检验或Fisher精确检验;计量资料两组间比较采用 t 检验或Mann-Whithey U 检验。结果 与术前相比,两组患者术后WBC均升高、PLT均降低,差异均有统计学意义(冷冻消融组: t 值分别为-7.480、-4.280;微波消融组: t值分别为-5.735、-3.075,P值均<0.001),其中冷冻消融组PLT变化更显著( Z=-4.457,P <0.001);两组患者术后ALT、AST、 TBil水平均升高且差异均有统计学意义(冷冻消融组: Z值分别为-4.457、-4.445、-4.229;微波消融组Z值分别为-3.617、-4.703、-4.228,P 值均<0.001),其中冷冻消融组ALT、AST变化更显著(Z值分别为-3.411、-3.829,P值均<0.05);冷冻消融组患者术后IL-6、HGF、VEGFA水平均升高且差异均有统计学意义(Z值分别为-4.076、-4.311、-3.123,P值均<0.05),与微波消融组相比,冷冻消融组IL-6、HGF、VEGFA变化更显著( Z值分别为-2.735、-2.578、-2.201,P 值均<0.05)。结论 与微波消融相比,冷冻消融术后短期内可诱发更显著的急性炎症反应,可能导致更高的术后并发症及肿瘤复发率。

Effect of cryoablation versus microwave ablation on clinical indices and cytokines in patients with hepatocellular carcinoma

Objective To investigate the changes in clinical indices and cytokines in peripheral blood after cryoablation or microwave ablation in patients with hepatocellular carcinoma (HCC) and related clinical significance. Methods A total of 62 patients with HCC who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from June to December, 2018, were enrolled, and according to the treatment regimen, these patients were divided into cryoablation group with 30 patients and microwave ablation group with 32 patients. The two groups were compared in terms of routine blood test results [white blood cell count (WBC), hemoglobin, and platelet count (PLT)], liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), and albumin], coagulation function (international normalized ratio), and peripheral blood cytokines [interleukin-2, tumor necrosis factor-α, interleukin-6 (IL-6), interleukin-8, hepatocyte growth factor (HGF), and vascular endothelial growth factor A (VEGFA)] at 1 week before surgery and on day 2 after surgery. The chi-square test and the Fisher’s exact test were used for comparison of categorical data between groups, and the t -test and the Mann-Whitney U test were used for comparison of continuous data between groups. Results Both groups had a significant increase in WBC and a significant reduction in PLT after surgery (cryoablation group: t =-7.480 and -4.280, both P <0.001;microwave ablation group: t =-5.735 and -3.075, both P <0.001), and the cryoablation group had a significantly greater reduction in PLT than the microwave ablation group (Z=-4.457, P <0.001). Both groups had significant increases in ALT, AST, and TBil after surgery (cryoablation group: Z=-4.457,-4.445, and -4.229, all P <0.001;microwave ablation group: Z =-3.617,-4.703, and -4.228, all P <0.001), and the cryoablation group had significantly greater increases in ALT and AST than the microwave ablation group ( Z=-3.411 and -3.829, both P <0.001). The cryoablation group had significant increases in IL-6, HGF, and VEGFA after surgery (Z=-4.076,-4.311, and -3.123, all P <0.05), with significantly greater increases than the microwave ablation group ( Z=-2.735,-2.578, and -2.201, all P <0.05). Conclusion Compared with microwave ablation, cryoablation can induce a higher level of acute inflammatory response within the short term after surgery, which may lead to higher rates of postoperative complications and tumor recurrence.