血清nm23-H1水平对肝细胞肝癌TACE治疗预后的影响

Impact of serum nm23-H1 level on the prognosis of hepatocellular carcinoma after transcatheter arterial chemoembolization treatment

目的探讨肝细胞肝癌患者血清nm23-H1基因水平及其对TACE治疗预后的影响。方法收集60例行TACE治疗的肝细胞肝癌患者血清,采用ELISA检测血清nm23-H1水平,并与12例正常对照组进行比较。回顾性分析所有患者的临床病理资料,对患者血清nm23-H1水平与临床资料进行相关性分析,用Kaplan-Meier生存曲线分析患者生存率,并用log等级检验比较。多因素分析方法评估血清nm23-H1水平及相关因素对预后的意义。结果肝细胞肝癌患者血清nm23-H1平均水平为(126.4±51.3)ng/ml,明显低于正常对照组的(228.3±38.9)ng/ml(P<0.01)。患者血清nm23-H1水平与白蛋白水平呈负相关(r=-0.256,P=0.048),而与患者年龄及血清AFP、ALT、AST、GGT、胆红素水平均无相关性。随访1周～83个月,中位随访时间为17.5个月。单因素分析显示肝外转移、门静脉瘤栓、动静脉瘘和血清AFP升高是预后不良的因素。多因素COX模型分析显示血清nm23-H1水平是影响生存的因素之一。结论血清nm23-H1水平有可能作为肝细胞肝癌患者TACE治疗疗效观察及预后判断的有用指标。

Objective To discuss the impact of serum nm23-H1 level on the prognosis of hepatocellular carcinoma （HCC） after transcatheter arterial chemoembolization （TACE） treatment.Methods By using enzyme-linked immunosorbent assay （ELISA） serum nm23-H1 levels were measured in randomly-selected 60 patients with HCC who received TACE.The results were compared with that of 12 healthy subjects.All patients＇ clinical data were retrospectively analyzed.Serum nm23-H1 levels were correlated with clinical data of the HCC patients.The patients＇ survival rates were analyzed with Kaplan-Meier survival curves and compared by the log-rank test.The prognostic significance of serum nm23-H1 levels and factors related to survival rate were evaluated by multivariate analysis.Results The mean serum nm23-H1 level in HCC patients was （126.4 ± 51.3） ng /ml,which was significantly lower than that in healthy subjects （228.3 ± 38.9） ng /ml （P 0.001）.A significant negative correlation existed between serum nm23-H1 level and serum albumin level （r=-0.256,P=0.048）.The serum nm23-H1 level carried no significant correlations with the patient＇s age or with the levels of serum AFP,ALT,AST,GGT and bilirubin.A follow-up for one week to 83 months （median time of 17.5 months） was conducted.Single factor analysis showed that extra-hepatic metastasis,portal vein tumor thrombus,arterio-venous fistula formation and high serum AFP levels were unfavorable prognosis factors.By multivariate analysis,serum nm23-H1 level was proved to be one of the potential prognostic factors affecting the survival rate.Conclusion Serum nm23-H1 level may be used as an important reference for evaluating the therapeutic effect and judging the prognosis in patients with HCC after TACE treatment.