斑蝥酸钠维生素B6联合经皮肝动脉化疗栓塞对原发性肝癌患者血清sFasL/sFas的影响

目的对比分析原发性肝癌(primary liver carcinoma,PLC)、慢性乙型肝炎(chronic hepatitis B,CHB)患者及健康体检者血清可溶性Fas配体(soluble Fas ligend,sFasL)及sFas水平,并动态观察联合应用斑蝥酸钠维生素B6及经皮肝动脉化疗栓塞(transcatheter hepatic arterial chemoembolization,TACE)治疗前后PLC患者血清sFasL、sFas水平变化,探讨PLC早期诊断和预后判断的可靠指标。方法选择PLC患者40例(初发26例,复发14例),采用斑蝥酸钠维生素B6注射液联合TACE治疗,酶联免疫吸附试验检测治疗前、治疗后1、3、6个月血清sFasL/sFas水平,同步检测血清白蛋白(albumin,ALB)、丙氨酸转氨酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBIL)水平。另选CHB患者及健康体检者各20例作为对照组。结果 PLC患者血清sFasL、sFas水平显著高于CHB组及健康对照组,尤以复发PLC增高为著。PLC初发、PLC复发、CHB和健康对照组血清sFasL水平依次为(86.21±28.47)μg/L、(317.56±139.54)μg/L、(43.62±9.96)μg/L和(26.61±7.93)μg/L;sFas依次为(51.15±22.97)μg/L、(107.13±27.19)μg/L、(16.81±6.34)μg/L、(21.57±7.95)μg/L,PLC复发组血清sFasL和sFas水平显著高于其余各组(P<0.01);PLC初发组显著高于CHB和健康对照组(P<0.01或<0.05)。PLC治疗后1、3、6个月血清sFasL为(150.32±27.95)μg/L、(82.52±15.07)μg/L、(34.66±5.26)μg/L;sFas为(102.09±27.92)μg/L、(30.59±6.79)μg/L、(21.20±3.19)μg/L,治疗后1个月sFasL、sFas水平较治疗前显著升高(P<0.01);治疗后3个月sFas及治疗后6个月sFasL、sFas水平均较治疗前显著降低(P<0.05及P<0.01)。治疗前后血清ALB、ALT及TBIL水平无明显变化。结论血清sFasL、sFas水平为PLC发病及进展的重要标志;斑蝥酸钠维生素B6联合TACE治疗PLC可通过调节凋亡基因sFasL、sFas的表达促进肿瘤细胞凋亡,抑制肿瘤生长。

Effect of disodium cantharidinate and vitamin B6 injection combined TACE on serum levels of soluble Fas ligand and Fas in primary liver carcinoma

Objective To elucidate the effect of disodium cantharidinate and vitamin B6 injection in combination with transcatheter hepatic arterial chemoembolization（TACE） on serum levels of soluble Fas ligend（sFasL） and Fas（sFas） in patients with primary liver carcinoma（PLC）.Methods Fourty patients including 26 PLC and 14 PLC recurrence cases underwent disodium cantharidinate and vitamin B6 injection in combination with TACE treatment.The serum sFasL,sFas,albumin（ALB）,alanine aminotransferase（ALT） and total bilirubin（TBIL） were tested before and after the treatment for 1,3 and 6 months.20 chronic hepatitis B（CHB） patients and 20 healthy volunteers served as the controls.Results The serum sFasL and sFas levels in PLC patients,especially in the recurrent PLC patients,were significantly higher than those in CHB patients and the health controls（P0.01,P0.05）.In PLC,recurrent PLC,CHB and health control group,the sFasL was respectively（86.21±28.47） μg/L,（317.56±139.54） μg/L,（43.62±9.96） μg/L and（26.61±7.93） μg/L;the sFas was（51.15±22.97） μg/L,（107.13±27.19） μg/L,（16.81±6.34） μg/L and（21.57±7.95） μg/L,respectively.After treatment for 1,3 and 6 months,the levels of sFasL and sFas in PLC patients were（150.32±27.95） μg/L,（82.52±15.07） μg/L,（34.66±5.26） μg/L and（102.09±27.92） μg/L,（30.59±6.79） μg/L,（21.20±3.19） μg/L,respectively.When compared with the baseline,the sFasL and sFas in PLC patients increased significantly after treatment for 1 month（P0.01）,the sFas reduced significantly after treatment for 3 months（P0.05） and both sFasL and sFas decreased after treatment for 6 months（P0.01）.There were no significant change in serum ALB,ALT and TBIL through treatment.Conclusion The serum sFasL and sFas are important markers for prediction and prognosis of PLC.Combination of disodium cantharidinate and vitamin B6 with TACE could accelerate apoptosis and inhibit proliferation of hepatocellular carcinoma by modulating sFasL and sFas.