微波消融对老年原发性肝癌患者肝功能的影响

Influence of microwave ablation on liver function in the elderly with hepatocellular carcinoma

目的比较老年组与中青年组原发性肝癌（HCC）患者微波消融治疗后肝功能、胆碱酯酶、白蛋白等实验室检测指标的变化。方法回顾性地研究2013年1月1日至2013年12月31日于解放军总医院介入超声科行超声引导下微波消融治疗的单发HCC患者343例，其中老年组（年龄〉60岁）131例，中青年组（年龄≤60岁）212例。结果老年组患者微波消融治疗后白细胞（WBC）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TB）均较治疗前明显升高，血清白蛋白（Alb）及胆碱酯酶（ChE）较治疗前明显下降（P〈0．01），中青年组HCC患者微波消融治疗后WBC、AIJT、AST、TB显著升高（P〈0．01），而消融治疗后ChE轻度升高及Alb轻度下降，但与治疗前相比差异无统计学意义（P〉0．05）。将两组患者消融治疗前后WBC、ChE、AIJT、AST、Alb、TB的差值进行组问比较，发现中青年组患者ALT升高较老年组患者明显（P=0．048），余指标消融治疗前后改变两组之间差异均无统计学意义（P〉0．05）。结论微波消融治疗后两组患者均出现反映肝功能的指标明显升高，反映肝脏储备功能的ChE和Alb在老年患者较中青年患者下降更加明显，说明老年患者肝脏储备功能更差。

Objective To compare the change in liver function, cholinesterase （ChE） and albumin （Alb） between the old and young patients with hepatocellular carcinoma （HCC） before and after microwave ablation （MWA）. Methods Three hundred and forty-three HCC patients with single hepatic lesion admitted in our department from Jan. 2013 to Dec. 2013 were recruited in this retrospective study. The patients were divided into the aged group （ 〉60 years old, n = 131 ） and the young group （ ≤60 years old, n = 212 ） , and all given percutaneous ultrasound guided MWA. Results The white blood cell （WBC） count, and alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total bilirubin （TB） levels were significantly increased, while the levels of Alb and ChE were decreased obviously in the aged group after MWA （ P 〈 0.01 ）. But for the young group, the WBC count and levels of ALT, AST and TB were remarkably elevated （ P 〈 0. 01 ） after the treatment, and that of ChE was raised slightly while that of Alb reduced, though without significant difference when compared with the levels before MWA （P 〉 0.05）. The young group had the level of ALT increased more significantly than the aged group （ P = 0. 048 ）, but no such differences were found in other indicators. Conclusion The indicators of liver function are increased in both young and aged HCC patients after MWA. But the levels of ChE and Alb, indicating liver reserve function, are decreased more obviously in the aged group than in the young group, which suggested that the elderly HCC patients have worse liver reserve function.