血清碱性磷酸酶及乳酸脱氢酶评价肝癌切除术后生存预后的价值

Survival prognosis of serum alkaline phosphatase and lactate dehydrogenase after resection of liver cancer

目的探讨血清碱性磷酸酶(ALP)及乳酸脱氢酶(LDH)在评价肝癌切除术后生存预后方面的价值。方法回顾性分析重庆三峡中心医院2010年1月至2013年12月收治的195例行肝癌切除术后患者的临床病理资料,于术后2周检测患者的ALP和LDH值,并据此将其分为ALP正常组(92例)和高水平组(103例),LDH正常组(88例)和高水平组(107例);比较血清ALP、LDH正常组与高水平组的临床病理资料、肿瘤复发转移率及生存率、采用Cox回归分析影响患者生存预后的危险因素。结果ALP高水平组的肿瘤复发转移率高于正常组(48.5%vs.14.1%),LDH高水平组的肿瘤复发转移率高于正常组(49.5%vs.13.6%),差异均有统计学意义(P<0.01)。ALP、LDH高水平组肿瘤直径>5 cm、AST>35 U/L、Ⅲ期及中低分化患者的比例高于正常组,差异有统计学意义(P<0.05)。随访60个月,ALP、LDH正常组的生存率(54.4%、58.5%)均高于高水平组(33.1%、30.0%)。肿瘤直径>5 cm、TNM分期Ⅲ期、AST>35 U/L、ALP>140 U/L、LDH>250 U/L、肿瘤分化程度低是影响肝癌患者术后生存预后的危险因素。结论ALP、LDH升高患者的生存率较低,ALP、LDH可作为影响肝癌切除术后患者生存预后的因素;术后ALP、LDH值升高对肿瘤复发转移判断有一定参考意义。

Objective To investigate the prognostic significance of serum alkaline phosphatase(ALP)and lactate dehydrogenase(LDH)after hepatectomy.Methods Retrospective analysis of the clinicopathological data of 195 patients with liver cancer resection from January 2010 to December 2013 in Chongqing Three Gorges Central Hospita was performed.The ALP and LDH values were detected at 2 weeks after operation.The patients were divided into ALP normal group(n=92)and ALP high level.Group(n=103),LDH normal group(n=88)and LDH high level group(n=107);The rates of recurrence and metastasis between different groups were compared.Cox regression analysis was performed to investigate the risk factors of prognosis.Results The rate of tumor recurrence and metastasis in the high-level ALP group was higher than that in the normal group(48.5%vs.14.1%),and the rate of tumor recurrence and metastasis in the high-level LDH group was higher than that in the normal group(49.5%vs.13.6%).The difference were statistically significant(P<0.01).The proportion of patients with high-level ALP and LDH tumors>5 cm,AST>35 U/L,stage Ⅲ and moderately poorly differentiated patients was higher than that in the normal group(P<0.05).After 60 months of follow-up,the survival rates of the normal ALP and LDH groups(54.4%,58.5%)werehigher than those of the high-level group(33.1%,30.0%).Tumor diameter>5 cm,TNM stage Ⅲ,AST>35 U/L,ALP>140 U/L,LDH>250 U/L,and low tumor differentiation were the risk factors for postoperative survival prognosis in patients with liver cancer.Conclusions The survival rate of patients with high level of ALP and LDH is low.ALP and LDH can be used as factors influencing the prognosis of patients after liver cancer resection.The increase of postoperative ALP and LDH values have certain reference significance for tumor recurrence and metastasis.