肝细胞癌患者TACE治疗前后血清miR-145水平变化及其临床意义

Significance of blood miR-145 in patients with hepatocellular carcinoma after TACE treatment

目的探讨肝细胞癌(HCC)患者在经导管动脉化疗栓塞术(TACE)治疗前后血清microRNA-145(miR-145)水平变化及其临床意义。方法2013年1月~2015年12月我院收治的72例HCC患者和同期60例健康体检者,采用qRT-PCR法检测血清miR-145水平,采用ROC曲线分析血清miR-145和甲胎蛋白(AFP)预测不良预后的价值。结果在治疗1个月末,16例(22.2%)为PR,13例(18.1%)为SD,43例(59.7%)为PD;HCC组血清miR-145水平为(0.59±0.25),显著低于对照组[(1.02±0.28),P<0.05],术后1个月,HCC患者血清miR-145水平为(0.81±0.26),显著高于术前(P<0.05);不同性别、年龄、肿瘤直径、肿瘤分化、癌栓和Child-Pugh分级患者血清miR-145水平无显著性差异(P>0.05),而不同TNM分级和术前AFP水平患者之间差异显著(P<0.05);PD组血清miR-145水平为(0.86±0.21),显著高于PR组或SD组[分别为(0.62±0.19)和(0.75±0.19),P<0.05];随访3年,28例(38.9%)患者死亡,其中高miR-14水平患者3 a生存率为75.6%,显著高于低水平患者的41.9%(x 2=8.765,P<0.05);血清miR-145、AFP和miR-145联合AFP预测HCC不良预后的曲线下面积分别为0.871、0.851和0.942,两者联合预测的敏感度为91.7%,准确度为90.2%。结论TACE术后检测血清miR-145水平可能预示HCC患者预后较好。

Objective The aim of this study was to investigate the significance of blood miR-145 levels in patients with hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE)treatment.Methods 72 patients with HCC and 60 healthy persons were recruited in our hospital between January 2013 and December 2015,and blood miR-145 levels were detected by qRT-PCR.The diagnostic performance of serum miR-145 and alpha-fetoprotein(AFP)in predicting prognosis were compared by ROC curve analysis.Results One month after TACE treatment,16 patients(22.2%)got PR,13 patients(18.1%)got SD,and 43 patients(59.7%)got PD results;the blood miR-145 level in patients with HCC was(0.59±0.25),significantly lower than[(1.02±0.28),P<0.05]in the control,and blood miR-145 level in the HCC group 1 month after TACE was(0.81±0.26),significantly increased as compared to that before TACE(P<0.05);the blood miR-145 levels in patients with HCC were related to TNM grades and preoperative serum AFP level(P<0.05);the miR-145 level in patients with PD response was(0.86±0.21),significantly higher than[(0.62±0.19)or(0.75±0.19),respectively,P<0.05]in patients with PR or SD;at the end of 3 year follow-up,28 patients(38.9%)died;the 3 annual overall survival rate in HCC patients with high level of miR-14 was 75.6%,significantly higher than 41.9%in patients with low miR-14 level(x 2=8.765,P<0.05);the areas under the ROC of blood miR-145,serum AFP and miR-145 plus AFP in predicting the poor prognosis of patients with HCC were 0.871,0.851 and 0.942,respectively,with the sensitivity and accuracy of combined prediction being 91.67%and 90.15%,respectively.Conclusion The detection of blood miR-145 might predict the prognosis of patients with HCC after TACE,which needs further investigation.