摘要
目的探讨阴虚型HBV相关原发性肝癌(PLC)患者的肿瘤特征及淋巴细胞计数与生化指标的相关性。方法收集2013年7月-2015年2月于首都医科大学附属北京地坛医院治疗的PLC患者148例,分为阴虚型PLC组(n=52)和非阴虚型PLC组(n=96)。收集患者的一般资料及实验室指标,包括肿瘤学指标[甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原(CA)19-9],病毒学指标(HBs Ag),肿瘤大体分型(结节型、块状型、巨块型、弥漫型),影像学特征(门静脉主干内径、门静脉癌栓、肝外转移),生化指标[终末期肝病模型(MELD)评分、白细胞(WBC)、红细胞(RBC)、血小板(PLT)、ALT、AST、TBil、GGT、ALP、白蛋白(Alb)、胆碱酯酶(CHE)、凝血酶原时间(PT)、凝血酶原活动度(PTA)]和淋巴细胞计数。符合正态分布的计量资料组间比较采用t检验,相关性分析采用Pearson相关分析;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验,相关性分析采用Spearman相关分析。计数资料组间比较采用χ2检验。结果 2组患者的HBs Ag比较差异有统计学意义(χ2=5.658,P=0.017)。与非阴虚型PLC组相比,阴虚型PLC患者的CEA和CA19-9水平升高,2组间比较差异有统计学意义(U值分别为-2.200、-2.194,P值均<0.05),MELD评分、TBil、PT升高(t=2.2、U=-2.0、U=-2.0,P值均<0.05),PLT和PTA降低(U=-3.1、t=-2.5,P值均<0.05),淋巴细胞、T淋巴细胞、CD8+T淋巴细胞、CD4+T淋巴细胞计数均降低(t=-2.7、U=-2.6、t=-2.2、U=-2.9,P值均<0.05)。阴虚型PLC患者的CD4+T淋巴细胞计数与PLT、PTA呈正相关(r值分别为0.360、0.295,P值均<0.05);CD8+T淋巴细胞计数与PLT、PTA呈正相关(r值分别为0.352、0.464,P值均<0.05),与MELD评分、TBil、PT呈负相关(r值分别为-0.358、-0.378、-0.520,P值均<0.05)。结论阴虚型PLC患者较其他证型肝癌患者肝脏合成功能更差、胆汁淤积更明显、免疫功能更为低下,且患者的CD4+T淋巴细胞计数越低,凝血功能越差;CD8+T淋巴细胞计数越低,凝血功能和肝脏储备功能均差。
Objective To investigate the tumor features and the correlation between lymphocyte count and biochemical parameters in patients with hepatitis B virus- associated primary liver cancer（ PLC） with yin deficiency. Methods A total of 148 PLC patients who were treated in Beijing Ditan Hospital,Capital Medical University,from July 2013 to February 2015 were enrolled and divided into yin- deficiency PLC group（ 52 patients） and non- yin- deficiency PLC group（ 96 patients）. The patients’ general information and laboratory markers were collected,including oncological parameters（ alpha- fetoprotein,carcinoembryonic antigen（ CEA）,and carbohydrate antigen 199（ CA19- 9））,virological parameter（ HBs Ag）,gross type（ nodular type,massive type,bulky type,and diffuse type）,radiological features（ main portal vein diameter,portal vein tumor thrombus,and extrahepatic metastasis）,biochemical parameters（ Model for End- Stage Liver Disease（ MELD） score,white blood cell,red blood cell,platelet（ PLT）,alanine aminotransferase,aspartate aminotransferase,total bilirubin（ TBil）,gamma- glutamyl transpeptidase,alkaline phosphatase,albumin,cholinesterase,prothrombin time（ PT）,and prothrombin time activity（ PTA））,and lymphocyte count. The t- test was applied for comparison of normally distributed continuous data between groups,and the Pearson correlation analysis was applied for correlation analysis. The Mann- Whitney U test was applied for comparison of non- normally distributed continuous data between groups,and the Spearman correlation analysis was applied for correlation analysis. The chi- square test was applied for comparison of categorical data between groups. Results HBs Ag showed a significant difference between the two groups（ χ2= 5. 658,P = 0. 017）. Compared with the non- yin- deficiency PLC group,the yin- deficiency PLC group had significantly increased CEA and CA19- 9（ U =- 2. 200 and- 2. 194,both P 〈 0. 05）,significantly increased MELD score,TBil,and PT（ t = 2. 2,U=- 2. 0,U =- 2. 0,all P 〈 0. 05）,and significantly reduced PLT and PTA（ U =- 3. 1,t =- 2. 5,both P 〈 0. 05）,as well as significantly reduced lymphocyte,T lymphocyte,CD8＋T lymphocyte,and CD4＋T lymphocyte（ t =- 2. 7,U =- 2. 6,t =- 2. 2,U =- 2. 9,all P 〈 0. 05）. In the PLC patients with yin deficiency,CD4＋T lymphocyte count was positively correlated with PLT and PTA（ r = 0. 360 and 0. 295,both P 〈 0. 05）; CD8＋T lymphocyte count was positively correlated with PLT and PTA（ r = 0. 352 and 0. 464,both P 〈 0. 05）and was negatively correlated with MELD score,TBil,and PT（ r =- 0. 358,- 0. 378,and- 0. 520,all P 〈 0. 05）. Conclusion Compared with the liver cancer patients with other syndrome types,PLC patients with yin deficiency have a worse liver synthetic function,more significant cholestatic symptoms,and a lower immune function,and coagulation function tends to become worse when CD4＋T lymphocyte count decreases. With the decreasing CD8＋T lymphocyte count,coagulation function and liver reserve function become worse.
出处
《临床肝胆病杂志》
CAS
2016年第3期509-513,共5页
Journal of Clinical Hepatology
基金
北京市自然科学基金(7142081)
首都中医药研究专项课题(14ZY05)
北京卫生系统高层次人才培养项目(2013-3-026)
关键词
肝肿瘤
肝炎病毒
乙型
肝肾阴虚
淋巴细胞计数
生物因子
liver neoplasms
hepatitis B virus
liver-kidney yin deficiency
lymphocytes count
biological factors
