血清维生素E和胡萝卜素β以及维生素A与原发性肝癌死亡率的相关性研究

Correlation of Serum Vitamin E,Carotene β and Vitamin A Levels with the Mortality in Primary Liver Cancer Treated with Radical Hepatic Carcinectomy

目的探讨血清3种维生素(维生素E、胡萝卜素β以及维生素A)参与调控氧化应激损伤与原发性肝癌患者死亡率之间的相关性。方法选取2010年1月—2013年1月于武汉科技大学附属天佑医院就诊的初发原发性肝癌术后患者198例。随访3年,根据随访结束时生存结果,分为存活组(n=101)和死亡组(n=97)。分别于术后1个月和术后3个月检测血清维生素E、胡萝卜素β、维生素A水平和氧化应激指标,包括总抗氧化态(TAS)、总氧化态(TOS)和氧化应激指数(OSI)以及其变化差值。结果死亡组术后3个月维生素E水平、维生素E变化差值、维生素A变化差值均低于存活组(P<0.05)。死亡组术后3个月TAS水平、TAS变化差值、TOS变化差值、OSI变化差值均低于存活组,术后3个月TOS水平、OSI高于存活组(P<0.05)。术后3个月维生素E水平和维生素E变化差值预测肝癌术后3年死亡事件发生的受试者工作特征曲线下面积(AUC)分别为0.798[95%CI(0.716,0.894)]、0.894[95%CI(0.735,0.934)]。术后3个月维生素E水平与术后3个月TAS水平呈正相关(r=0.521,P<0.05),与死亡率呈负相关(r=-0.611,P<0.05);维生素E变化差值与死亡率呈负相关(r=-0.653,P<0.05)。多因素Logistic回归分析结果显示,术后3个月维生素E>10.1μmol/L[OR=0.78,95%CI(0.40,0.98)]和维生素E变化差值>0.6μmol/L[OR=0.89,95%CI(0.49,0.99)]是肝癌术后3年死亡事件发生的独立影响因素(P<0.05)。结论原发性肝癌患者术后3个月维生素E水平是肝癌术后3年死亡事件发生的潜在预测因子。

Objective To estimate the correlation of 3 kinds of serum vitamin（ E,carotene β and A） levels involved in oxidative stress injury with the mortality in primary liver cancer patients with radical hepatic carcinectomy. Methods The participants enrolled in this study were 198 consecutive primary liver cancer patients treated by radical hepatic carcinectomy in Tianyou Hospital Affiliated to Wuhan University of Science Technology from January 2010 to January 2013. Based on the survival status found at the end of 3-year follow-up period,they were divided into the survival group（ n = 101） and death group（ n = 97）. The serum vitamin（ E,carotene β and A） levels and oxidative stress markers [total anti-oxidative status（ TAS）,total oxidative status（ TOS） and oxidative stress index（ OSI） ]of the participants were measured at 1,and 3 months after the surgery and the difference between the two measured values of the above items（ △VitE,△Vitcarotene β,△VitA,△TOS,△TAS and △OSI） were calculated. Results Compared with the survival group,the death group had lower serum vitamin E values measured at the time of 3 months after the surgery,less △VitE,less △VitA（ P〈0. 05）. The TAS measured at the time of 3 months after the surgery was lower, △TAS and △TOS and △OSI values were all less, but TOS and OSI measured at the time of 3 months after the surgery were higher in the death group than in the survival group（ P〈0. 05）. For predicting the postoperative 3-year mortality,the AUC value of serum vitamin E measured at the time of 3 months after surgery was 0. 798 [95% CI（ 0. 716,0. 894） ],and that of △VitE was 0. 894 [95% CI（ 0. 735,0. 934） ]. In all the participants,a positive correlation existed between serum vitamin E and TAS measured at the time of 3 months after surgery（ r = 0. 521,P〈0. 05）,while a negative correlation existed between serum vitamin E and mortality（ r =-0. 611,P〈0. 05）,and a negative correlation was found between serum vitamin E measured at the time of 3 months after surgery and mortality（ r =-0. 653,P〈0. 05）. Multivariate Logistic regression analysis found that, the independent influencing factors for postoperative 3-year mortality in the participants were serum vitamin E value measured at the time of 3 months after surgery 10. 1 μmol/L [OR= 0. 78,95% CI（ 0. 40,0. 98）,P〈0. 05]and △VitE 0. 6 μmol/L [OR = 0. 89,95% CI（ 0. 49,0. 99）,P〈0. 05].Conclusion The serum vitamin E value measured at the time of 3 months after surgery may be a potential predictor for the postoperative 3-year mortality in primary liver cancer patients with radical hepatic carcinectomy.