肝癌肝移植术前血浆D-二聚体水平与血管侵犯及肝癌分期的相关性

Correlation Between Plasma D-Dimer Level and Vascular Invasion as well as the Pittsburgh Modified TNM Staging in Patients with Hepatocellular Carcinoma for Orthotopic Liver Transplantation

目的 分析肝癌肝移植术前血浆D 二聚体水平升高在瘤栓形成及微血管侵犯中的评估意义以及与肝癌PittsburghTNM分期的相关性。方法 采用金标法定量检测了 12 0例肝癌肝移植患者术前血浆D 二聚体水平 ;根据全肝切除后病理分析主支血管内瘤栓形成、微血管侵犯情况 ,对患者病情进行PittsburghTNM分期、Child Pugh分级 ,运用统计软件SPSS 9.0行分层 χ2 检验、多因素方差分析及 q检验。结果 在Child PughA、B、C级主支血管内有瘤栓形成者与无血管侵犯者血浆D 二聚体水平的差异有显著性意义 (P<0 .0 5 ) ;在Child PughB、C级有微血管侵犯者与无血管侵犯者血浆D 二聚体水平差异有显著性意义 (P<0 .0 1) ,在Child PughA级上差异无显著性意义 (P>0 .0 5 ) ;肿瘤TNM分期Ⅰ、Ⅱ期与Ⅲ期和Ⅳ期间D 二聚体水平差异有显著性意义 (P<0 .0 5 ) ,Ⅲ期与Ⅳ期间差异无显著性意义 (P>0 .0 5 )。结论 血浆D 二聚体水平随PittsburgTNM分期升高而升高 ,对肝癌肝移植术前微血管侵犯及瘤栓形成的评估有参考价值 ,且随着血管侵犯进展和Child Pugh分级增高而其相关性增高。

Objective To evaluate the prognostic value of plasma D dimer level in cancer thrombosis and vascular invasion assessment and to analyze the correlation between plasma D dimer level and the Pittsburgh modified TNM staging in patients with hepatocellular carcinoma for orthotopic liver transplantation. Methods The plasma D dimer level was quantitated using Golden method in 120 patients with hepatocellular carcinoma for orthotopic liver transplantation. Cancer thrombosis in trunk vein and microvascular invasion was diagnosed by pathology. The relationship between plasma D dimer level in different Child pugh’s classification patients and vascular invasion as well as the Pittsburgh modified TNM staging was analyzed with χ 2 test, factorial analysis of variance and q test by microsoft SPSS 9.0.Results In Child Pugh’s A, B and C patients, the difference of plasma D dimer level between patients with trunk vein cancer thrombosis and patients without vascular invasion was significant ( P <0.05). The differences of plasma D dimer level between patients with microvascular invasion and patients without vascular invasion were significant ( P <0.01) in Child Pugh’s B and C patients but was insignificant in Child Pugh’s A patients ( P >0.05). The differences of plasma D dimer level between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅲ tumor, and between patients with the Pittsburgh modified TNM Ⅰand Ⅱ tumor and patients with TNM Ⅳ tumor were significant ( P <0.05), but the differences of plasma D dimer level between patients with the Pittsburgh modified TNM Ⅲ tumor and patients with TNM Ⅳ tumor were insignificant ( P > 0.05). Conclusion Plasma D dimer level, which increasing as upgrade of the Pittsburgh TNM staging, is useful in the vascular invasion and cancer thrombosis assessment in patients with hepatocellular carcinoma for liver transplantation, and the correlation was more significant as progression of vascular invasion and upgrade of Child pugh’s classification.