肝细胞癌患者微波消融治疗前后血清异常凝血酶原水平变化及临床意义

目的 研究肝细胞癌(HCC)患者微波消融治疗前后血清异常凝血酶原(DCP)及AFP水平变化,并对HCC复发进行监测,探讨血清DCP、AFP水平与复发的关系。方法 选择2015年12月-2018年2月在首都医科大学附属北京佑安医院住院治疗并经肝穿刺活组织病理检查确诊为HCC的患者76例,检测患者微波消融术前、术后、复发时血清DCP及AFP水平并进行分析。非正态分布的计量资料2组之间比较采用Mann-WhitneyU检验,3组之间比较采用Kruskal-WallisH检验;2组样本的相关性检验采用Spearman相关分析。结果 HCC患者微波消融术后1周血清DCP及AFP与术前相比明显下降(Z值分别为6.854、6.246,P值均<0.01),术后1个月血清DCP及AFP相比术前及术后1周进一步下降,差异均有统计学意义(DCP:Z值分别为11.639、4.786,AFP:Z值分别为10.058、3.812,P值均<0.01)。76例HCC患者中59例出现肿瘤复发,复发时其血清DCP及AFP水平均高于术后1周及术后1个月,差异均有统计学意义(DCP:Z值分别为-4.671、-8.521,AFP:Z值分别为-3.423、-6.311,P值均<0.01)。复发组患者微波消融术前血清DCP及AFP水平均高于未复发组患者(Z=-3.010,P=0.003;Z=-2.387,P=0.017)。复发组患者微波消融术后1个月血清DCP水平高于未复发组(Z=-3.498,P<0.001)。伴有肝外远处转移或血管侵犯的复发组患者术前及术后1个月血清DCP水平均高于单纯肝内肿瘤复发组(χ2值分别为23.597、18.228,P值均<0.001)。相关分析结果显示,HCC复发患者术前及术后1个月血清DCP水平均与复发时间呈负相关(r值分别为-0.500、-0.651,P值均<0.01)。结论HCC患者微波消融前后血清DCP水平监测有助于判断微波消融疗效及预测复发,并对判断预后有一定的参考价值。

Change in serum level of abnormal prothrombin after microwave ablation for hepatocellular carcinoma and its clinical significance

ObjectiveTo investigate the changes in serum levels of des-γ-carboxy-prothrombin (DCP) and alpha-fetoprotein (AFP) after microwave ablation in patients with hepatocellular carcinoma (HCC), to monitor the recurrence of HCC, and to investigate the association of serum DCP and AFP levels with the recurrence of HCC. MethodsA total of 76 patients who were hospitalized and treated in Beijing YouAn Hospital, Capital Medical University, from December 2015 to February 2018 and were diagnosed with HCC by liver biopsy were enrolled. The serum levels of DCP and AFP were measured before and after microwave ablation and at the time of recurrence. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups;the Spearman correlation analysis was used to investigate correlation. ResultsAt 1 week after microwave ablation, the HCC patients had significant reductions in the serum levels of DCP and AFP ( Z= 6.854 and 6.246, both P <0.01), which further decreased at 1 month after microwave ablation (DCP: Z =11.639 and 4.786, both P <0.01;AFP: Z =10.058 and 3.812, both P <0.01). Of all 76 HCC patients, 59 experienced recurrence, and the serum levels of DCP and AFP at the time of recurrence were significantly higher than the levels at 1 week and 1 month after microwave ablation (DCP: Z =-4.671 and -8.521, both P <0.01;AFP: Z =-3.423 and -6.311, both P <0.01). Before microwave ablation, the recurrence group had significantly higher serum levels of DCP and AFP than the non-recurrence group ( Z =-3.010 and -2.387, P =0.003 or P =0.017);at 1 month after microwave ablation, the recurrence group had a significantly higher serum level of DCP than the non-recurrence group ( Z =-3.498, P <0.001). In the recurrence group, the patients with extrahepatic distant metastasis or vascular invasion had a significantly higher serum level of DCP than those with intrahepatic recurrence alone before and at 1 month after microwave ablation (χ 2 =23.597 and 18.228, both P <0.01). Correlation analysis showed that in HCC patients with recurrence, serum DCP level before and at 1 month after microwave ablation was negatively correlated with time to recurrence ( r=-0.500 and -0.651, both P <0.01). ConclusionMonitoring of serum DCP level before and after microwave ablation in HCC patients helps to judge the clinical effect of microwave ablation and predict recurrence and prognosis.