血浆D-二聚体评估TACE治疗原发性肝癌的疗效

Plasma D-dimer in evaluation of clinical efficacy of TACE for treatment of primary hepatic carcinoma

目的探讨血浆D-二聚体评估TACE治疗原发性肝癌(PHC)疗效的价值。方法收集接受TACE治疗的PHC患者86例,测量术前1周内(D0)、术后1个月(D1)及疾病进展时(D2)血浆D-二聚体水平。首次TACE治疗1个月后,按实体瘤疗效评价标准修订版将患者分为病情控制组及病情进展组,记录患者的无进展生存期(PFS)。比较病情控制组与病情进展组的D0、D1血浆D-二聚体水平,分析D0、D1、D2血浆D-二聚体水平与PFS的相关性,并评估血浆D-二聚体与PFS的关系。结果病情控制组D0、D1血浆D-二聚体水平差异无统计学意义(P>0.05),病情进展组D1血浆D-二聚体水平高于D0(P=0.000 1),且病情进展组D0、D1血浆D-二聚体水平均高于病情控制组(P均<0.05)。D0、D1、D2血浆D-二聚体水平均与PFS呈负相关(r_s=-0.267、-0.454、-0.368,P均<0.05),D1、D2时血浆D-二聚体水平阴性者较血浆D-二聚体水平阳性者PFS长(P均<0.05)。结论血浆D-二聚体水平可作为评估PHC患者的病情、TACE疗效及预后的生物学指标,D-二聚体升高是其不利因素。

Objective To explore the value of plasma D-dimer in evaluating therapeutic effect of TACE for primary hepatic carcinoma（PHC）.Methods Data of 86 PHC patients treated with TACE were selected,and the plasma D-dimer levels before TACE within a week（D0）,1 month after TACE（D1）and during disease processing（D2）were measured.One month after intervention,the patients were divided into disease control group and progressive disease group according to modified response evaluation criteria in solid tumors,and the progression-free survival（PFS）was recorded.The plasma D-dimer levels were compared at D0 and D1 between two groups,and the correlation of D-dimer levels at D0,D1,D2 with PFS was analyzed respectively.The relation of plasma D-dimer levels and PFS was evaluated.Results There was no statistical difference of plasma D-dimer levels between D0 and D1 in disease control group（both P〈0.05）,but plasma Ddimer levels at D1 were higher than those at D0 in progressive disease group（P=0.000 1）.At D0 and D1,D-dimer levels in progressive disease group were higher than those in disease control group（both P〈0.05）.D-dimer levels at D0,D1 and D2 were negatively correlated with PFS（rs=-0.267,-0.454,-0.368,all P〈0.05）.Compared with positive D-dimer levels,patients with negative D-dimer levels at D1,D2 possessed longer PFS（both P〈0.05）.Conclusion The level of plasma D-dimer can serve as a biomarker to evaluate PHC patients＇ state,therapeutic effect of TACE and prognosis.High D-dimer is a risk factor for PHC patients.