红细胞计数对原发性肝癌患者术后生存期的预测价值

Predictive value of red blood cell count for postoperative survival of patients with primary liver cancer

目的探讨红细胞计数在原发性肝癌患者术后生存期预测中的应用价值。方法选择2007年1月至2012年12月于本院行切除手术的原发性肝癌患者120例为研究对象。应用全自动血液分析仪和生化分析仪检测血液中各项指标,并结合患者的临床资料和病历资料,采用Kaplan-Meier法进行累积生存时间曲线的绘制,采用Cox比例风险回归模型进行多因素分析,确定影响累积生存时间的因素。结果 120例原发性肝癌患者的平均年龄为(56.98±14.39)岁,以男性、伴肝硬化、无PVTT、TNM分期Ⅲ～Ⅳ期、Child-Pugh分级A期、肿瘤大小≥5 cm、RBC<(3.5～5.0)×10^(12)/L患者居多。不同RBC水平患者的PVTT、肿瘤大小、Child-Pugh分级、TNM分期、TBil、ALT、AST、AST/ALT、ALP、GGT、ALB、A/G及PT的差异有统计学意义(P均<0.05)。单因素Logistic回归分析结果显示PVTT、肿瘤大小、Child-Pugh分级、TNM分期、TBil、ALT、AST、AST/ALT、ALP、GGT、ALB、A/G、RBC和PT是影响原发性肝癌患者累积生存时间的危险性因素(P均<0.05)。多因素Logistic回归分析结果显示Child-Pugh分级为B级和C级、TNM分期为Ⅲ～Ⅳ期、AST/ALT高于标准、GGT高于标准、RBC低于标准是影响原发性肝癌患者累积生存时间的危险性因素(P均<0.05)。随访5年后,标准RBC数量的原发性肝癌患者累积生存率为33.33%(11/33),低于标准RBC数量的原发性肝癌患者累积生存率为26.44%(23/87),差异有统计学意义(χ~2=5.22,P=0.007)。结论原发性肝癌患者术前血液中RBC数量低于标准是影响其累积生存时间的危险性因素之一。RBC计数在原发性肝癌患者术后生存期预测中具有重要意义,对于患者的病情进展具有一定的提示价值。

Objective To explore the predictive value of red blood cell count for postoperative survival of patients with primary liver cancer. Methods Total of 120 cases with primary liver cancer（PLC） who underwent resection operation in our hospital from January 2007 to December 2012 were selected. The blood indicators were detected by automatic blood analyzer and blood biochemical analyzer. The cumulative survival curve was drew by KaplanMeier method according to the clinic data and medical records of the patients. Cox proportional hazards regression model was used for multivariate analysis to determine the factors that affected cumulative survival time. ResultsThe average age of the 120 cases with PLC was（56.98 ± 14.39） years, patients who were male, with cirrhosis, without PVTT, TNM Ⅲ～Ⅳ, Child-Pugh A grade, tumor size ≥ 5 cm and RBC 〈（3.5～5.0）× 10^12/L were in the majority. PVTT, tumor size, Child-Pugh stage, TNM stage, TBil, ALT, AST, AST/ALT, ALP, GGT, ALB, A/G and PT in PLC patients with different RBC levels had statistical significance（P〈0.05）. Single factor Logistic regression analysis showed that PVTT, tumor size, Child-Pugh stage, TNM stage, TBil, ALT, AST, AST/ALT, ALP, GGT, ALB, A/G, RBC and PT were the risk factors of survival time in patients with primary liver cancer（P〈0.05）. Multi factor Logistic regression analysis showed that Child-Pugh B and C grade, TNM Ⅲ～Ⅳ stage, AST/ALT and GGT higher than the standard and RBC lower than the standard were the risk factors of cumulative survival time in patients with primary liver cancer（P〈0.05）. After 5 years of follow-up, the survival rate of standard count of red blood cells in patients with primary liver cancer [33.33%（11/33）] was higher than that of the low RBC count patients with primary liver cancer [26.44%（23/87）], the difference was statistically signifiant（χ~2 = 5.22, P = 0.007）.Conclusions The blood number of RBC lower than the standard was one of the risk factors affecting the survival time of patients with primary liver cancer. RBC count had great significance in predicting the survival time of patients with primary liver cancer, and it also had a certain value for the disease progression.