射频消融联合肝动脉化疗栓塞对HCC患者炎性、氧化应激反应及肿瘤活性因子指标影响

Effect of radiofrequency ablation combined with transcatheter arterial chemoembolization on inflammatory factors,oxidative stress response factors and tumor activity factors in patients with primary liver cancer

目的:探讨射频消融(RFA)联合肝动脉化疗栓塞(TACE)对原发性肝癌(HCC)患者炎性因子、氧化应激反应因子及肿瘤活性因子指标的影响。方法:选择2014年1月~2016年6月100例原发性肝癌患者,随机分为观察组与对照组,各50例,其中观察组给予RFA联合TACE治疗,对照组单纯给予TACE治疗,比较两组治疗前(T0)及治疗1周(T1)、2周(T2)炎性因子、氧化应激反应因子及肿瘤活性因子指标。结果:(1)T1两组超敏C反应蛋白(hsCRP)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平呈明显增高,T2显著下降,T1>T1>T2,但观察组T1hs-CRP、IL-6、TNF-α水平高于对照组,差异有统计学意义(hs-CRPt_(T1)=22.135,IL-6t_(T1)=101.446,TNF-αt_(T1)=131.055,P<0.05),T2两组hsCRP、IL-6、TNF-α水平差异无统计学意义(hs-CRPt_(T2)=5.856,IL-6t_(T2)=2.461,TNF-αt_(T2)=2.584,P>0.05);(2)T1观察组活性氧(ROS)水平高于对照组,超氧化物歧化酶(SOD)与总抗氧化能力(T-AOC)水平低于对照组;T2观察组ROS水平低于对照组,SOD、T-AOC水平高于对照组,差异有显著统计学意义(ROSt_(T1)=136.137,SODt_(T2)=81.352,T-AOCt_(T1)=11.065,ROSt_(T2)=95.185,SODt_(T1)=109.124,T-AOCt_(T2)=26.987,P<0.05)。(3)观察组T1、T2血清甲胎蛋白(AFP)、糖类抗原CA199、基质金属蛋白酶(MMP)水平低于对照组,差异有统计学意义(AFPt_(T1)=263.754,CA199t_(T1)=112.342,MMPt_(T1)=45.675,AFPt_(T2)=86.764,CA199t_(T2)=42.376,MMPt_(T2)=37.352,P<0.05)。结论:RFA治疗HCC尽管早期有导致机体炎症状态和氧化应激加剧的现象,但其联合TACE治疗HCC可有效改善机体微炎症状态,特别是能提高机体抗氧化功能,降低肿瘤活性因子水平。

Objective：To investigate the effects of radiofrequency ablation（RFA）combined with transcatheter arterial chemoembolization（TACE）on inflammatory factors,oxidative stress response factors and tumor activity factors in primary hepatocellular carcinoma（HCC）patients.Methods：A total of 100 cases of primary liver cancer patients from January 2014 to June 2016 were selected and randomly divided into observation group and control group with 50 cases in each group,the observation group was treated with RFA combined with TACE treatment,the control group was given TACE treatment,compared two groups before treatment（T0）,1weeks of treatment（T1）,2weeks（T2）inflammation factor,oxidative stress factor and tumor activity index.Results：1 The hs-CRP,IL-6and TNF-αlevels of T1 in two groups were significantly increased,T2 decreased ignificantly,T1〉 T1〉 T2,but the observation group hs-CRP,IL-6,TNF-αlevels of T1 were higher than the control group and the difference was statistically significant（hs-CRPt（T1）=22.135,IL-6t（T1）=101.446,TNF-αt（T1）=131.055,P〈0.05）,hs-CRP,IL-6,TNF-αlevels of T2 had no statistically significant（hs-CRPt（T2）=5.856,IL-6t（T2）=2.461,TNF-αt（T2）=2.584,P〉0.05）;2 The ROS level of T1 in the observation group was higher than the control group,while the SOD and TAOC levels were lower than the control group,the ROS level of T2 in the observation group was lower than the control group,SOD and T-AOCwere higher than the control group,there was significant difference（ROSt（T1）=136.137,SODt（T2）=81.352,T-AOCt（T1）=11.065.ROSt（T2）=95.185,SODt（T1）=109.124,T-AOCt（T2）=26.987,P〈0.05）.3Serum AFP,CA199 and MMP levels in T1 and T2of the observation group were lower than the control group,the difference was statistically significant（AFPt（T1）=263.754,CA199 t（T1）=112.342,MMPt（T1）=45.675,AFPt（T2）=86.764,CA199 t（T2）=42.376,MMPt（T2）=37.352,P〈0.05）.Conclusions：RFA treatment of HCC may lead to inflammation and increased oxidative stress in the early stage.However,TACE combined with TACE can improve the microinflammatory state,especially enhance the antioxidant function and decrease the level of tumor active factor.