肝癌手术切除术前外周血中CD4+/CD8+值及总胆汁酸的量与患者预后相关性分析

Analyis of Correlation between the CD4+/CD8+ Values in the Peripheral Blood before the Liver Cancer Surgery and Total Bile Acid Amount and Prognosis of Patients

目的探讨术前外周血中CD4+/CD8+值及血清总胆汁酸的量在预测患者预后中的价值。方法方便选择2012年1月—2014年6月住院接受肝癌部分切除的77例患者作为研究对象,测定术前患者外周血中CD4+/CD8+值及血清中总胆汁酸(TBA)含量,手术后对患者进行随访,并对患者性别、年龄、术前CD4+/CD8+值、TBA值及肿瘤情况,术后远处转移,复发情况进行系统性分析。结果术前低CD4+/CD8+值组患者术后第1年复发率58.62%,第3年复发率89.66%均显著高于高CD4+/CD8+值组的8.33%和20.83%(P<0.05);低TBA值组患者第1年及第3年肿瘤复发率25.00%和43.75%均低于高TBA值组的42.22%和88.89%(P<0.05);经单因素方差分析发现,术前CD4+/CD8+值大小(χ~2=26.141,P<0.001)、TBA值大小(χ~2=13.573,P=0.002)、肿瘤直径大小(χ~2=5.831,P=0.008)、肿瘤浸润深度(χ~2=9.187,P=0.003)、肿瘤分化程度(χ~2=3.643,P=0.018)、有无淋巴结转移(χ~2=11.545,P=0.002)以及有无微血管侵犯(χ~2=7.624,P=0.005)是影响肝癌切除手术后患者生存率的高风险因素,且经多因素分析结果显示,上述临床特征也为影响肝癌切除术后患者3年内生存率的独立危险因素。结论肝癌手术切除术前低CD4+/CD8+值(≤1)及高TBA值(>45μmol/L)患者的预后较差,复发率较高。

Objective To study the value of CD4+/CD8+ values in the peripheral blood before surgery and total bile acid amount in predicint the value of prognosis. Methods 77 cases of patients with partial hepatectomy for liver cancer before surgery in our hospital from January 2012 to June 2014 were convenient selected as the research objects and the CD4 +/CD8 + value and serum TBA content of patients before surgery were measured and the patients were followed up after surgery and the gender, age, postopertive CD4 +/CD8 + values and TBA value and tumor situation of patients, recurrence were systematically analyzed. Results The 1-year recurrence rate and 3-year recurrence rate in the low CD4+/CD8+ value group before surgery was obviously higher than that in the high CD4 +/CD8 + value group,(58.62%, 89.66% vs 8.33%,20.83%)(P<0.05), and the 1-year tumor recurrence rate and 3-year tumor recurrence rate in the low TBA value group were higher than those in the high TBA group,(25.00%, 43.75% vs 42.22%, 88.89%), P <0.05, and the single factor variance analysis showed that the CD4+/CD8+ value size(χ~2=26.141,P<0.01) and TBA value(χ~2=13.573,P=0.02), tumore diameter size(χ~2=5.831,P=0.08), tumor invasion depth(χ~2=9.187,P=0.003), degree of tumor differentiation(χ~2=3.643,P=0.003),whether there was lymphatic metastasis or not(χ~2=11.545,P=0.002) and whehter there was microvascular invasion are the high risk factors of surival rate of patients(χ~2=7.624,P =0.005), and the multiple factors analysis results showed the the above the clinical features were the independent risk factors of affecting the 3-year surival rates. Conclusion The prognosis of low CD4+/CD8+ value(≤1) and high TBA value(> 45μmol/L) before the liver cancer incision surgery is worse and the recurrence rate is high.