摘要
目的分析原发性肝癌(PHC)患者术后血清胰岛素样生长因子-2(IGF-2)、甲胎蛋白(AFP)、碱性磷酸酶(ALP)、r-谷氨酰转移酶(γ-GT)水平的变化及临床意义。方法我院收治的120例PHC患者(PHC组),手术前后均采血测定IGF-2、AFP、ALP、γ-GT水平,并与同期正常体检者30例(对照组)进行对比,分析手术对PHC患者各因子水平的影响,并按随访1年复发情况分为复发与未复发组,比较两组上述指标的差异,分析各因子的相关关系,采用受试者工作曲线(ROC)分析四者单独及联合预测PHC术后复发的价值。结果PHC组血清IGF-2、AFP、ALP、γ-GT水平高于对照组(P<0.05),不同临床分期IGF-2、AFP、ALP、γ-GT水平比较:Ⅰ期<Ⅱ期<Ⅲ期(P<0.05);PHC患者根治术后不同时间血清IGF-2、AFP、ALP、γ-GT均低于基线水平,术后4周各指标水平低于术后1周(P<0.05);复发组血清IGF-2、AFP、ALP、γ-GT水平高于未复发组(P<0.05);IGF-2、AFP、ALP、γ-GT四者互相均呈正相关关系(P<0.05);ALP约登指数最大时预测PHC术后1年复发曲线下面积(AUC)为0.917,敏感性、特异性分别为88.89%、100.00%;四者联合对PHC术后1年复发的预测价值高于单独指标,约登指数最大时AUC为0.919,敏感性、特异性分别为89.56%、100.00%。结论PHC患者血清IGF-2、AFP、ALP、γ-GT呈异常高表达,根治术后以上各因子均明显降低,四者均参与PHC发病及病情进展过程,且与患者术后复发有关,可能为评估PHC预后的新方向。
Objective To analyze the changes in levels of serum insulin-like growth factor-2(IGF-2),alpha-fetoprotein(AFP),alkaline phosphatase(ALP)and r-glutamyltransferase(r-GT)in patients with primary hepatic carcinoma(PHC)after surgery and their clinical significance.Methods One hundred and twenty patients with PHC in our hospital were enrolled as PHC group.Before and after surgery,blood sampling was conducted to measure levels of IGF-2,AFP,ALP and r-GT.They were compared with 30 normal people who underwent physical examination in our hospital during the same period.The effects of surgery on levels of various factors in the PHC patients were analyzed.The cancer patients were further divided into recurrence group and non-recurrence group according to recurrence condition during 1-year follow-up.The differences in the above indexes were compared between the two groups.The correlations among the above factors were explored.The value of single and combined prediction of the four indicators for recurrence after surgery of PHC was analyzed with the receiver operating characteristic(ROC)curve.Results The levels of serum IGF-2,AFP,ALP and r-GT in the PHC group were significantly higher than those in the control group(P<0.05).With increase of clinical stages,the levels of IGF-2,AFP,ALP,and r-GT were increased,showing stage I<stage II<stage III(P<0.05).After radical operation,levels of serum IGF-2,AFP,ALP and r-GT in the PHC patients were lower than baseline levels.After 4 weeks of surgery,the above indexes were lower than those at 1 week after surgery(P<0.05).The levels of serum IGF-2,AFP,ALP and r-GT in the recurrence group were higher than those in the non-recurrence group(P<0.05).There was positive correlations among IGF-2,AFP,ALP and r-GT(P<0.05).When the Youden index was the largest,the area under the curve(AUC),sensitivity and specificity of ALP for predicting recurrence during 1 year after surgery of PHC were 0.917,88.89%and 100.00%,respectively.The value of combined prediction of the four indicators for recurrence during 1 year after surgery of PHC was greater than that of single indicator.When the Youden index was the largest,the AUC,sensitivity and specificity of combined detection were 0.919,89.56%and 100.00%,respectively.Conclusions The levels of serum IGF-2,AFP,ALP and r-GT are abnormally high in patients with PHC.After radical operation,the above factors are significantly decreased.All of them are involved in the onset and progression of PHC and are related to postoperative recurrence,which may be a new direction for predicting the prognosis of PHC.
作者
罗羽鸥
杨晓玲
李川
LUO Yu-ou;YANG Xiao-ling;LI Chuan(Department of Liver Surgery,West China Hospital,Sichuan University,Chengdu 610041,China)
出处
《实用医院临床杂志》
2020年第1期186-190,共5页
Practical Journal of Clinical Medicine
基金
四川省科技厅科研基金资助项目(编号:2019YJ0149)
关键词
原发性肝癌
手术
甲胎蛋白
胰岛素样生长因子
碱性磷酸酶
Γ-谷氨酰转移酶
Primary hepatic carcinoma
Surgery
Alpha-fetoprotein
Insulin-like growth factor
Alkaline phosphatase
R-glutamyltransferase
