摘要
目的探讨血清YKL-40和AFP联合检测对肝细胞癌患者手术预后判断的价值。方法回顾性分析2011年7月至2012年12月于山东大学齐鲁医院肝胆外科接受根治性切除术的158例肝细胞癌患者的临床资料,选择同期门诊健康体检者245例作为对照组。按血清YKL-40与AFP水平,将158例肝细胞癌患者分成4组,A组(39例):YKL-40、AFP均正常;B组(30例):YKL-40正常、AFP升高;C组(42例):YKL-40升高、AFP正常;D组(47例):YKL-40、AFP均升高。采用ELISA法检测肝细胞癌患者血清YKL-40水平。生存分析采用Kaplan-Meier法绘制生存曲线,应用Log-rank进行检验,采用Cox比例风险模型进行单因素及多因素分析。结果肝细胞癌患者血清YKL-40水平显著高于正常对照组(t=3.307,P<0.001),且与患者肿瘤数目和TNM分期密切相关(χ~2=9.885、5.667,P=0.002、0.017)。Log-rank检验显示4组间的总生存率和无复发生存率差异均有统计学意义(χ~2=9.350、10.982,P=0.025、0.001)。将组间总生存率无显著差异(χ~2=4.493,P=0.128)的B、C、D组和并为E组(119例),组间无复发生存率无显著性差异(χ~2=4.493,P=0.128)的A、B、C组和并为F组(111例)。A组(YKL-40和AFP均正常)总生存率显著高于E组(YKL-40和AFP单独或均升高)(χ~2=6.128,P=0.014),D组(YKL-40和AFP均升高)无复发生存率显著低于F组(YKL-40和AFP单独增高或均正常)(χ~2=11.275,P<0.001)。多因素Cox回归分析显示,YKL-40与AFP联合指标是肝细胞癌的独立预后因素。结论 YKL-40与AFP联合检测对肝细胞癌预后的判断更为准确,可作为肝细胞癌病理分期判断预后的有益补充。
Objective To investigate the value of combined detection of serum YKL-40 and AFP on the prognosis of patients with hepatocellular carcinoma after surgery. Methods Clinical data of 158 patients who underwent radical resection of hepatocellular carcinoma admitted into Qilu Hospital of Shandong University from July 2011 to December 2012 were retrospectively analyzed. Total of 245 healthy cases in the same period were included as health control. According to the serum level of YKL-40 and AFP, patients with hepatocellular carcinoma were divided into four groups： group A （39 cases）： YKL-40 and AFP were both normal; group B （30 cases）： YKL-40 were normal and AFP elevated; group C （42 cases）：YKL-40 elevated and AFP were normal; group D （47 cases）： YKL-40 and AFP both elevated. The serum YKL-40 level was determined by enzyme-linked immunosorbent assay （ELISA）. The survival curves were constructed using the Kaplan-Meier method and compared by the log-rank test. The Cox proportional hazards regression model was performed to identify the independent prognostic factors. Results The serum YKL-40 level in patients with hepatocellular carcinoma after surgery was significantly higher than that in healthy individuals （t = 3.307, P 〈 0.001）, and it was correlated with tumor number and TNM stages （χ^2 = 9.885, 5.667; P = 0.002, 0.017）. The log-rank test showed that there were significant differences among the four groups in the overall survival and recurrencefree survival （χ^2 = 9.350, 10.982; P = 0.025, 0.001）. The B, C and D groups which had no differences on their overall survival （χ^2 = 4.493, P =0.128） were merged into group E （119 cases） and the A, B and C groups without differences on their recurrence-free survival （χ^2 = 4.493, P = 0.128） were merged into group F （111 cases）. The overall survival in group A （normal YKL-40 and low AFP） were better （χ^2 = 6.128, P = 0.014）than that of group E （YKL-40 and AFP solely or both elevated） and the rate of recurrence-free survival of group D （elevated YKL-40 and high AFP group） were lower （χ^2 = 11.275, P 〈 0.001） than that of group F （YKL-40 and AFP solely elevated or were both normal）. Multivariate Cox regression analysis showed that the combination of YKL-40 and AFP was an independent prognostic factor for patients with hepatocellular carcinoma. Conclusion The combination of YKL-40 and AFP serum YKL-40 could potently predict the outcomes of patients with HCC and it may be a beneficial recruitment for TNM stages determination on prognosis of patients after surgery.
出处
《中国肝脏病杂志（电子版）》
CAS
2017年第1期61-67,共7页
Chinese Journal of Liver Diseases：Electronic Version
