肝细胞癌患者血清Dickopff 1水平对TACE治疗后预后的影响

目的 探讨肝细胞癌患者血清Dickopff相关蛋白1(Dickopff-1)水平对TACE治疗后预后的影响。方法 2016年1月～2018年1月在我院住院经导管动脉化疗栓塞术(TACE)治疗的HCC患者90例,选择同期在我院进行健康体检者90例,慢性乙型肝炎(CHB)患者86例,乙型肝炎肝硬化患者81例,采用ELISA法检测血清Dickopff-1和AFP水平,对HCC患者进行为期24个月的随访,绘制研究对象受试者工作特征曲线(ROC)并计算曲线下面积(AUC),确定血清Dickopff-1和AFP诊断HCC的效能,应用Kaplan-Meier曲线进行生存分析。结果 HCC组血清Dickopff-1和AFP水平显著高于肝硬化组 或CHB组【分别对(0.8±0.1)ng/ml和(12.3±3.0)ng/ml,P<0.05】或健康人【分别对(0.7±0.1)ng/ml和(11.5±2.5)ng/ml,P<0.05】; TACE治疗后HCC患者血清Dickopff-1水平降至(1.6±0.6)ng/ml(P<0.05);有癌栓的HCC患者血清Dickopff-1水平显著高于无癌栓患者;死亡患者血清Dickopff-1水平显著高于生存患者;血清Dickopff-1和AFP单独诊断HCC的AUC分别为0.860和0.618,对HCC都有一定的诊断价值( Z=6.297,P<0.05);血清Dickopff-1和AFP联合应用能提高诊断效能(AUC=0.892),其诊断的灵敏度、特异度和准确度均最高;Kaplan-Meier生存分析显示,高血清Dickopff-1水平患者总体生存率显著低于低水平组(x²=8.418,P<0.05)。结论 HCC患者血清Dickopff-1水平升高,其水平越高,在TACE治疗后预后越差,是否可以作为HCC患者在TACE治疗后疗效和预后判断的指标,值得研究。

Serum level of dickopff 1 in patients with hepatocellular carcinoma and its impact on prognosis after TACE treatment

Objective To investigate serum level of dickopff 1 in patients with hepatocellular carcinoma (HCC) and its impact on prognosis after transcatheter arterial chemoembolization (TACE) treatment. Methods 90 patients HCC, 90 healthy persons, 86 patients with chronic hepatitis B (CHB) and 81 patients with hepatitis B cirrhosis were enrolled in this study from January 2016 to January 2018, and all patients with HCC received TACE and followed-up for 24 months. Serum levels of Dickopff-1 and AFP were measured by ELISA. Serum Dickopff-1 levels in patients with different clinical and pathological characteristics were compared. The receiver operating characteristic curve (ROC) was drawn to determine the efficacy of serum Dickopff-1 and AFP in the diagnosis of HCC, and the Kaplan-Meier curve was applied for survival analysis. Results Serum Dickopff-1 and AFP levels in patients with HCC were significantly higher than those in patients with liver cirrhosis or in patients with CHB【(0.8±0.1)ng/ml and (12.3±3.0)ng/ml, P<0.05】 or in healthy persons 【(0.7±0.1)ng/ml and (11.5±2.5)ng/ml, respectively, P<0.05】; serum level of dickopff-1 in patients with HCC reduced after TACE treatment to (1.6±0.6)ng/ml, P<0.05); serum level of dickopff-1 in HCC patients with portal cancer thrombus was higher than that in patients without (2.9±0.3) ng/ml vs. (2.1±0.5)ng/ml, P<0.05); serum level of dickopff-1 in dead patients was higher than that in survivals (3.5±0.8) ng/ml vs. (1.2±0.3) ng/ml, P<0.05); the area under the ROC curve (AUC) of serum dickopff-1 or AFP alone in the diagnosis of HCC were 0.860 and 0.618, respectively, which had certain diagnostic value for HCC (Z=6.297, P<0.05) and the combined diagnosis of dickopff-1 and AFP improved the efficacy (AUC=0.892), and the sensitivity, specificity and accuracy of the diagnosis were all the highest; the Kaplan-Meier survival analysis showed that the overall survival of patients with high serum dickopff-1 levels was poorer than that in patients with low serum levels (x²=8.418, P<0.05). Conclusion Serum dickopff-1 levels increase in patients with HCC. The higher the levels of serum dickopff-1 in patients with HCC, the worse the prognosis. It might be used as an indicator of the efficacy and prognosis after TACE treatment in patients with HCC.