巨块型原发性肝癌TACE前后sICAM-1变化的临床意义

目的探讨sICAM-l在判断巨块型原发性肝癌经肝动脉栓塞化疗术（TACE）治疗后的疗效方面的临床意义及sICAM-1与肿瘤活性的关系。方法采用酶联免疫吸附法（ELISA）检测16例巨块型原发性肝癌（肿瘤最大径10～17cm,13.73±1.27cm）患者首次TACE术前,术后1月,第二次术后1月和14例健康人血清细胞间黏附分子-1含量。对比TACE术前、术后1月血清sICAM-l水平变化与肿块体积大小及甲胎蛋白（AFP）变化的关系。结果TACE术前原发性肝癌患者sICAM-l的水平明显高于健康对照组sICAM-1的水平差异有统计学意义（p=0.001）,不同AFP组术前sICAM-l的水平无显著差异,术后1月sICAM-1的水平,与术前sICAM-l的水平比较显著下降（P〈0.001）,二次术后1月血清sICAM-1水平与正常组无显著差异（P=0.056）。第一次术后1个月肿瘤体积减小比例下降幅度与slCAM-1含量下降幅度成正相关,相关系数0.512,P〈0.05,术后slCAM-1变化水平与AFP变化呈正相关,相关系数0.584,P〈0.05。结论TACE能够降低巨块型原发性肝癌患者血清sICAM-1的水平,sICAM-1水平的变化与肿瘤负荷和活性密切相关。对巨块型肝癌病人,sICAM-1的含量在评价TACE疗效和判断再次TACE有一定的临床意义,尤其对AFP阴性者更有潜在优势。

Changes and significance of serum soluble intercellular adhesion molecule-1(sICAM-1) in huge primary hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization

Objective To observe the changes of serum soluble intercellular adhesion molecule-1（slCAM-1） in patients with huge primary hepatocellular carcinoma（PHC） before and after transcatheter arterial chemoembolization（TACE）,it was investigated to identify the clinical significance of sICAM-1 in estimating the effects of TACE and to explore the relation between sICAM-1 level and activity of the tumor.Methods Applying TACE skill to cure 16 cases with huge PHC（tumor largest DH from11cm-17cm,12.45±1.91cm）,serum sICAM-1 levels in 14 healthy persons and patients were detected by means of enzyme linked immunosorbent assay（ELISA） before and after TACE 1 month,and after the second TACE 1 month.Results Compared with control group,before the f irst TACE serum slCAM-1 in patients with PHC was signif icantly higher（P=0.001）.There was no significant difference between different AFP groups.One month after the intervention therapy serum slCAM-1 significantly decreased（P0.001）.With significant differences before and after the intervention therapy,serum slCAM-1 after the second TACE was not significantly higher than normal（P=0.056）.Furthermore,tumor volume diminution proportion after TACE for 1 month was correlated with decrease of slCAM-l（r= 0.512,P0.05） and the changes of slCAM-l were correlated with AFP（r= 0.584,P0.05）.Conclusion TACE can reduce serum sICAM-1 level in patients with huge PHC.sICAM-1 and tumor activity were closely related in huge PHC patients.sICAM-1 levels can help to judge the opportunity of TACE and estimate the effect of TACE,and especial to those whose AFP is negative.