原发性肝癌患者免疫球蛋白水平与介入治疗后肝纤维化的相关性

Correlation between immunoglobulin levels and liver fibrosis after interventional therapy in patients with primary liver cancer

[目的]观察原发性肝癌(PHC)患者免疫球蛋白(Ig)水平与介入治疗—肝动脉化疗栓塞术(TACE)治疗后肝纤维化(HF)的相关性,指导PHC患者合理免疫治疗及防治HF。[方法]选择218例PHC患者,记录患者基线资料[年龄、性别、肝功能Child-pugh分级、肝癌巴塞罗那(BCLC)分级、病程、血清谷草氨酸转移酶(AST)及谷丙氨酸转移酶(ALT)水平],均于介入治疗前检测其IgM、IgG、IgA水平,全部患者均接受TACE治疗,记录患者治疗后HF发生情况,比较介入治疗后HF患者和未发生HF患者的基线资料、Ig水平,分析PHC患者Ig水平对介入治疗后HF发生的影响及风险预测价值。[结果]218例PHC患者,经介入治疗后HF发生率为68.81%;HF组治疗前血清IgM、IgG及IgA水平均高于未发生HF组,差异有统计学意义(P<0.05);经二元Logistic回归分析后建立多元Logistic回归模型,结果显示,PHC患者治疗前血清IgM、IgG及IgA过表达均是介入治疗后HF发生的影响因素(OR>1,P<0.05);绘制受试者工作曲线(ROC)发现,PHC患者血清IgM、IgG、IgA水平预测介入治疗后HF发生风险的曲线下面积(AUC)均>0.80,均有一定预测价值。[结论]PHC患者免疫功能与介入治疗后HF发生有关,治疗前血清IgM、IgG、IgA过表达可增加介入治疗后HF发生风险,可将治疗前血清IgM、IgG、IgA水平用于预测介入治疗后HF发生风险,进一步制定针对性预防措施。

[Objective]To observe the correlation between the level of immunoglobulin(Ig)and liver fibrosis(HF)after interventional therapy in patients with primary liver cancer(PHC),to guide the reasonable immunotherapy and the prevention and treatment of liver fibrosis in patients with PHC.[Methods]The totals of 218 PHC patients were selected.The baseline data of patients[age, gender, Child-pugh classification of liver function, liver cancer Barcelona(BCLC)classification, course of disease, serum aspartate aminotransferase(AST)and alanine aminotransferase(ALT)levels],the levels of IgM,IgG,and IgA were detected before interventional therapy were recorded.After the transcatheter hepatic arterial chemoembolization(TACE)interventional therapy, the occurrence of HF after treatment in all the patients were recorded.The baseline data and Ig levels of patients with HF and patients without HF after interventional therapy was compared, the influence of Ig level in PHC patients on the occurrence of HF after interventional therapy and its risk prediction value were analyzed.[Results]In 218 PHC patients, the incidence of HF after interventional treatment was 68.81%;the levels of serum IgM,IgG and IgA before treatment in the HF group were higher than those in the non-HF group, and the difference was statistically significant(P<0.05).After binary logistic regression analysis, a multiple logistic regression model was established, and the results showed that the overexpression of serum IgM,IgG and IgA in PHC patients before treatment were all influencing factors of HF after interventional therapy(OR>1,P<0.05);the receiver operating curve(ROC)was drawn and the serum IgM,IgG,and IgA levels of PHC patients predicted the area under the curve(AUC)of the risk of HF after interventional therapy were all >0.80,which had certain predictive value.[Conclusion]The immune function of PHC patients is related to the occurrence of HF after interventional therapy.Over expression of serum IgM,IgG,and IgA before treatment can increase the risk of HF after interventional therapy.Serum IgM,IgG,and IgA levels before treatment can be used to predict the risk of HF after interventional therapy and to further develop targeted preventive measures.