天冬氨酸氨基转移酶与丙氨酸氨基转移酶比值在结直肠癌肝转移患者预后中的意义

Prognostic significance of aspartate aminotransferase to alanine aminotransferase ratio in colorectal cancer patients with liver metastasis

目的探讨外周血天冬氨酸氨基转移酶(AST)与丙氨酸氨基转移酶(ALT)(AST/ALT)比值对结直肠癌肝转移患者的预后价值。方法选取2014年1月至2018年1月郑州人民医院普通外科收治的118例结直肠癌合并肝转移患者,男76例,女42例,年龄(60.71±10.42)岁,年龄范围为27~75岁。将患者按照术前肝功能血清指标AST/ALT比值的中位数(1.15)分为高AST/ALT组和低AST/ALT组,每组59例。收集患者的基本资料和临床资料,包括性别、年龄、术前一周内AST和ALT水平、术前癌胚抗原水平、原发癌灶是否合并脉管瘤栓、原发癌灶分化程度、原发癌灶是否有淋巴结转移、原发癌灶浸润深度、肝转移癌灶的肿瘤直径、肝转移灶的癌灶个数、肝转移灶的癌灶分布,并进行比较。单因素及多因素分析AST/ALT是否是预后的影响因素。结果高AST/ALT组和低AST/ALT组间术前癌胚抗原、AST及ALT水平,原发癌灶的浸润深度,肝转移灶的肿瘤直径、癌灶个数及癌灶分布比较,差异有统计学意义(P<0.05);低AST/ALT组总生存期显著优于高AST/ALT组,差异有统计学意义(P<0.001);高AST/ALT比值是患者低生存期的独立危险因素。结论术前AST/ALT比值较高的结直肠癌肝转移患者预后较差,AST/ALT比值可作为临床预后参考指标之一。

Objective To investigate the prognostic value of aspartate aminotransferase(AST)and alanine aminotransferase(ALT)ratio(AST/ALT)in colorectal cancer patients with liver metastasis.Methods A retrospective study was performed on 118 cases of patients with colorectal cancer complicated with liver metastasis who were admitted from January 2014 to January 2018,76 cases of male,42 cases of female,aged(60.71±10.42)years old,ranging from 27 to 75 years old.Patients were divided into the high-AST/ALT group and the low-AST/ALT group according to the ratio of AST and ALT median(1.15),the serum indicators of preoperative liver function.The basic data and clinical data of patients were collected,including gender,age,preoperative AST and ALT levels within a week,carcinoembryonic antigen(CEA)levels of tumor markers,vascular tumors of primary lung cancer whether merger oven plug,primary lung cancer are focal differentiation degree,whether primary lung cancer are focal lymph node metastasis,primary lung cancer,liver metastatic carcinoma infiltration depth oven focal hepatic metastases tumor diameter,number,liver metastases of cancer distribution characteristics,and the comparison.Univariate and multivariate analyses were performed to determine whether AST/ALT was a prognostic factor.Results There were statistically significant differences in preoperative carcino-embroyonic antigen,AST and ALT levels,depth of primary cancer invasion,diameter,number and distribution of liver metastases between the high-AST/ALT and low-AST/ALT groups(P<0.05);the overall survival of the low-AST/ALT group was better than that of the high-AST/ALT group(χ2=12.995,P<0.001);high AST/ALT was an independent risk factor for low survival.Conclusion The prognosis of patients with liver metastasis from colorectal cancer with high preoperative AST/ALT ratio was poor.AST/ALT ratio could be used as one of the clinical prognostic indicators.