原发性肝癌中医证型与血清肿瘤标志物的关系研究

Relationship between TCM syndrome types of primary liver cancer and serum tumor markers

目的研究原发性肝癌患者不同中医证型与血清肿瘤标志物的关系。方法选取本院2015年1月至2019年12月收治的60例原发性肝癌患者,根据中医证型分为肝郁脾虚组(n=12)、肝胆湿热组(n=14)、肝热血瘀组(n=7)、脾虚湿困组(n=17)、肝肾阴虚组(n=10)。比较各组血清γ-谷氨酸转肽酶(γ-GT2)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)和甲胎蛋白(AFP)指标水平。结果肝热血瘀组、脾虚湿困组及肝肾阴虚组γ-GT2水平高于肝郁脾虚组及肝胆湿热组,差异具有统计学意义(P<0.05);脾虚湿困组CA19-9水平与其他组比较差异有统计学意义(P<0.05);肝郁脾虚组CEA水平与其他组比较差异具有统计学意义(P<0.05);肝胆湿热组、肝热血瘀组及肝肾阴虚组AFP水平显著高于肝郁脾虚组、脾虚湿困组,差异具有统计学意义(P<0.05)。γ-GT2、CEA、CA19-9和AFP肿瘤标记物在不同中医证型患者中所占比例存在差异,肝郁脾虚主要以CEA高表达为主;肝胆湿热主要以CEA及AFP高表达为主;肝热血瘀主要以γ-GT2、CA19-9和AFP高表达为主;脾虚湿困主要以γ-GT2及CA19-9高表达为主;肝肾阴虚主要以AFP表达为主。结论原发性肝癌患者在中医证型分型中可依据血清γ-GT2、CEA、CA19-9和AFP指标水平作为客观参考指标,为原发性肝癌提供参考指标,不同血清肿瘤标志物与原发性肝癌患者有一定相关性。

Objective To study the relationship of serum tumor marker levels in patients with primary liver cancer in different TCM syndrome types.Methods 60 patients with primary liver cancer admitted to our hospital from January 2015 to December 2019 were selected,according to their TCM they were divided into liver depression and spleen deficiency group(n=12),liver and gallbladder damp-heat group(n=14),liver and dampheat group(n=14),liver heat and blood stasis group(n=7),spleen deficiency and dampness group(n=17),liver and kidney Yin deficiency group(n=10).The serum levels ofγ-glutamate transpeptidase(γ-GT2),carcinoembryonic antigen(CEA),carbohydrate antigen 19-9(CA19-9)and alpha-fetoprotein(AFP)were compared among different groups.Results Theγ-GT2 levels in the liver heat and blood stasis group,the spleen deficiency and dampness group,and the liver and kidney Yin deficiency group were higher than those of the liver depression and spleen deficiency group and the liver and gallbladder damp-heat group,the difference was statistically significant(P<0.05);the level of CA19-9 in the spleen deficiency and dampness group was significantly different from other groups(P<0.05);the CEA level of the liver depression and spleen deficiency group were statistically different from other groups(P<0.05);the level of AFP in the liver and gallbladder damp-heat group,the liver heat and blood stasis group,and the liver and kidney Yin group were significantly higher than that of the liver depression and spleen deficiency group and the spleen deficiency and dampness group,the difference was statistically significant(P<0.05).The proportions ofγ-GT2,CEA,CA19-9 and AFP tumor markers in patients with different TCM syndrome types were different.Liver depression and spleen deficiency were mainly characterized by high expression of CEA;liver and gallbladder damp-heat mainly characterized by high expression of CEA and AFP;liver heat and blood stasis was mainly characterized by high expression ofγ-GT2,CA19-9 and AFP;spleen deficiency and dampness was mainly characterized by high expression ofγ-GT2 and CA19-9;liver and kidney Yin deficiency was mainly characterized by high expression of AFP.Conclusion The classification of patients with primary liver cancer can be based on serumγ-GT2,CEA,CA19-9 and AFP indicator level is used as objective reference indicator to provide reference indicator for primary liver cancer.Different serum tumor markers have certain correlation with patients with primary liver cancer.