CT微波消融术对原发性小肝癌患者预后、血清VEGF及MMPs影响分析

Analysis of the effect of CT microwave ablation on the prognosis, serum VEGF and MMPs in patients with primary small liver carcinoma

目的探讨CT微波消融术对原发性小肝癌患者的预后、血清血管内皮生长因子(vascular endothelial growth factor,VEGF)及基质金属蛋白酶(matrix metalloproteinases,MMPs)的影响。方法选择攀枝花市中心医院和泸州市中医院2013年1月至2015年1月收治的81例原发性小肝癌患者为研究对象。根据治疗方法不同将入选患者分为手术组(40例)和微波消融组(41例)。比较两组患者无瘤生存率、肝功能、血清VEGF和MMPs水平。结果两组患者术后1年、2年无瘤生存率比较均无显著差异(P>0.05),微波消融组患者术后3年无瘤生存率显著高于手术组(P<0.05)。治疗后,两组患者谷丙转氨酶(alanine aminotransferase,ALT)和谷草转氨酶(aspartate aminotransferase,AST)水平均显著高于治疗前(P<0.05),其中手术组患者ALT和AST水平均显著高于微波消融组(P<0.05)。治疗前两组患者血清VEGF水平比较无显著差异(P>0.05),但均高于正常水平。治疗后第1天两组患者血清VEGF水平急剧下降(P<0.05),治疗后第7天血清VEGF水平升高并高于治疗前(P<0.05),治疗后第30天血清VEGF水平显著降低并低于治疗前(P<0.05)。治疗后第1天、7天、30天,微波消融组患者血清VEGF水平均显著低于同期手术组(P<0.05)。治疗后两组患者血清MMP-2、MMP-9水平均显著低于治疗前(P<0.05),微波消融组患者血清MMP-2、MMP-9水平均显著低于手术组(P<0.05)。两组患者并发症发生率比较差异具有显著性(P<0.05)。结论与手术治疗相比,CT微波消融术可显著改善原发性小肝癌患者的预后,降低血清VEGF和MMPs水平,患者肝功能恢复快,并发症少,生存率高。

Objective To investigate the effect of CT microwave ablation on the prognosis, serum vascular endothelial growth factor（VEGF） and matrix metalloproteinases（MMPs） in patients with primary small liver carcinoma. Method 81 patients with primary small liver carcinoma in Panzhihua Central Hospital and Luzhou Hospital of Traditional Chinese Medicine from January 2013 to January 2015 were selected as the research subjects. According to the treatment, they were divided into operation group（40 cases） and microwave ablation group（41 cases）. The tumor free survival rate, liver function, serum VEGF and MMPs levels were compared between the two groups. Result The 1 year and 2 years tumor free survival rates after surgery between the two groups had no significant differences（P〈0.05）. The 3 years tumor free survival rates after surgery in microwave ablation group was significantly higher than that in operation group（P〈0.05）. After treatment, the levels of ALT and AST in the two groups were significantly higher than those before treatment（P〈0.05）, and the levels of ALT and AST in operation group were significantly higher than those in microwave ablation group（P〈0.05）. There was no significant difference in serum VEGF level between the two groups before treatment（P〈0.05）, but all above the normal level. On the first day after treatment, the serum VEGF level of the two groups decreased dramatically（P〈0.05）, the serum VEGF level increased seventh days after treatment and was higher than that before treatment（P〈0.05）. Thirtieth days after treatment, the serum VEGF level was significantly lower than that before treatment（P〈0.05）. On the first day, the seventh days and the thirtieth days after treatment, the serum VEGF levels in microwave ablation group were significantly lower than those in operation group at the same time（P〈0.05）. After treatment, the serum MMP-2 and MMP-9 levels in the two groups were significantly lower than that before treatment（P〈0.05）. The serum MMP-2 and MMP-9 levels in microwave ablation group were significantly lower than those in operation group（P〈0.05）. There was a significant difference in the incidence of complications between the two groups（P〈0.05）. Conclusion Compared with surgical treatment, CT microwave ablation can significantly improve the prognosis of patients with primary small liver cancer, reduce the levels of serum VEGF and MMPs, the patient＇s liver function recovery is fast, the complications are less, and the survival rate is high.