肝癌切除术前后患者血清sP-selectin、sICAM-1水平变化及其临床意义

Changes of serum sP-selectin and sICAM-1 levels before and after liver cancer resection and their clinical significance

目的观察原发性肝癌患者肝切除术前后血清可溶性P-选择素(sP-selectin)、可溶性细胞间粘附分子-1(sICAM-1)水平变化及其临床意义。方法选择2015年1月至2018年12月74例肝癌切除术患者为研究对象(肝癌组),另选择同期40例肝硬化患者(肝硬化组)、40例健康体检者(对照组),比较3组入院时血清sP-selectin、sICAM-1,观察肝癌患者手术前、术后1、3、6、9、12月血清sP-selectin、sICAM-1水平变化,记录患者术后12个月内复发率,并比较复发组与未复发组不同时间点sP-selectin、sICAM-1水平,绘制受试者工作特征曲线(ROC)曲线分析血清sP-selectin、sICAM-1水平对患者术后复发预测价值。结果入院时,血清sP-selectin、sICAM-1水平肝癌组肝硬化组、对照组差异有统计学意义(P<0.05),肝硬化组上述指标均显著高于对照组(P<0.05);患者术后1、3、6、9、12月血清sP-selectin、sICAM-1水平均均显著低于术前(P<0.05),其中术后1、3、6月血清sP-selectin、sICAM-1水平整体呈下降趋势,术后9、12月有上升趋势(P<0.05);术后进行12个月随访,共出现19例复发病例,复发率25.68%;复发组术后1月、3月血清sP-selectin、sICAM-1呈下降趋势,术后6、9、12月呈上升趋势,且均显著高于术后3月水平(P<0.05),未复发组术后1、3、6月血清sP-selectin、sICAM-1均呈下降趋势,术后9、12月呈上升趋势,且与术后6月比较差异不显著(P>0.05),但两组各时间点血清sP-selectin、sICAM-1水平均显著低于该组术前(P<0.05),且复发组术前、术后1、3、6、9、12月血清sP-selectin、sICAM-1水平均显著高于未复发组同时间点(P<0.05);绘制ROC曲线显示,sP-selectin、sICAM-1及联合预测术后复发的ROC曲线下面积分别为0.789、0.860、0.913(P<0.05)。结论肝癌患者血清sP-selectin、sICAM-1水平表达显著上升,经肝切除术后其水平可明显降低,且血清sP-selectin、sICAM-1水平对患者术后早期复发有一定预测价值。

Objective To observe the changes and clinical significance of serum soluble P-selectin(sP-selectin)and soluble intercellular adhesion molecule-1(sICAM-1)levels in patients with primary liver cancer before and after liver resection. Methods From January 2015 to December 2018,74 patients with liver cancer resection were selected as the research subjects(liver cancer group),and another 40 patients with liver cirrhosis(cirrhosis group)and 40 healthy examiners(control group)were selected during the same period. The levels of serum sP-selectin and sICAM-1 at admission were compared among the three groups. Changes in serum sP-selectin and sICAM-1 levels before surgery and at 1 month,3 months,6 months,9 months and 12 months after surgery were observed among patients with liver cancer. The recurrence rate within 12 months after surgery was recorded,and the levels of sP-selectin and sICAM-1 at different time points were compared between recurrence group and non-recurrence group. The receiver operator characteristic curve(ROC curve)was plotted to analyze the predictive value of serum sP-selectin and sICAM-1 levels on postoperative recurrence of patients. Results At admission,the levels of serum sP-selectin and sICAM-1 in the liver cancer group were significantly higher than those in the cirrhosis group and the control group(P<0.05),and the above indexes in the cirrhosis group were significantly higher than those in the control group(P<0.05). The levels of serum sPselectin and sICAM-1 at 1 month,3 months,6 months,9 months and 12 months after surgery were significantly lower than those before surgery(P<0.05),and the serum sP-selectin and sICAM-1 levels at 1 month,3 months and 6 months after surgery showed a downward trend as a whole,and showed an upward trend at 9 months and 12 months after surgery(P<0.05). 12 months of follow-up was performed after surgery,and there were 19 cases of recurrence,with the recurrence rate of 25.68%. The levels of serum sP-selectin and sICAM-1 in the recurrence group showed a downward trend at 1 month and 3 months after surgery,and showed a upward trend at 6 months,9 months and 12 months after surgery,and were significantly higher than those at 3 months after surgery(P<0.05). The levels of serum sP-selectin and sICAM-1 in the non-recurrence group showed a downward trend at 1 month,3 months and 6 months after surgery,and showed an upward trend at 9 months and 12 months after surgery,and there were no significant differences compared with those at 6 months after surgery(P>0.05),but the levels of serum sP-selectin and sICAM-1 at each time point in the two groups were significantly lower than those in the same group before surgery(P<0.05),and the levels of serum sPselectin and sICAM-1 at 1 month,3 months,6 months,9 months and 12 months after surgery in the recurrence group were significantly higher than those in the non-recurrence group at the same time point(P<0.05). The plotted ROC curves showed the values of area under the ROC curves of sP-selectin,sICAM-1 and combined prediction of postoperative recurrence were 0.789,0.860 and 0.913 respectively(P<0.05). Conclusion Serum levels of sP-selectin and sICAM-1 in patients with liver cancer increased significantly,and their levels could be significantly reduced after hepatectomy. Serum levels of sP-selectin and sICAM-1 have certain predictive value for early postoperative recurrence.