尿液N^(1),N^(12)-二乙酰精胺在肝细胞癌诊断及预后中的临床意义

Significance of urinary N^(1),N^(12)-diacetylspermine level in diagnosis and prognosis of hepatocellular carcinoma

目的研究N^(1),N^(12)-二乙酰精胺(N^(1),N^(12)-diacetylspermine,DiAcSpm)水平在肝细胞癌(hepatocellular carcinoma,HCC)患者尿液中的表达和临床意义。方法选取佛山市第一人民医院2017年8月至2018年8月住院的86例HCC患者和30例良性肝病患者,另从门诊健康体检中心选取50例健康体检者,采用免疫比浊竞争抑制法检测三组人群的尿液DiAcSpm水平。分析尿液DiAcSpm水平和HCC患者临床病理的关系,并探讨DiAcSpm对HCC患者术后复发的影响。结果HCC患者的尿液DiAcSpm水平高于健康体检者(P<0.05),而与良性肝病患者的差异无统计学意义(P>0.05)。HCC患者尿液DiAcSpm与血清甲胎蛋白水平存在一定的正相关(r=0.75,P<0.001)。DiAcSpm诊断HCC的敏感度为0.67,特异度为0.51。根据受试者操作特征曲线cut-off值[0.61μmol/(g·Cre)]将HCC手术患者分为高DiAcSpm组和低DiAcSpm组,两组年龄和性别差异均无统计学意义(均P>0.05);其中高DiAcSpm组TNM分期和巴塞罗那分期晚于低DiAcSpm组(均P<0.05),而血管浸润在高DiAcSpm组患者中的比例高于低DiAcSpm组(P<0.05);高DiAcSpm组HCC患者中位无瘤生存时间与低DiAcSpm组差异无统计学意义(P>0.05)。结论DiAcSpm在HCC患者的尿液中表达升高,可能与肝癌的发生和发展密切相关,有望成为HCC早期诊断和手术预后监测的有效指标。

Objective To investigate the expression and the significance of urinary N^(1),N^(12)-diacetylspermine(DiAcSpm)in the diagnosis and prognosis of hepatocellular carcinoma(HCC)patients.Method 86 HCC patients and 30 benignant liver disease patients admitted to the First People's Hospital of Foshan from August 2017 to August 2018 were selected as the study subjects,another 50 healthy persons from physical examination center of the hospital were also included.Urinary DiAcSpm level in the three groups were detected by turbidimetric inhibition immuno assay.The relationship between urinary DiAcSpm level and clinicopathological characteristics of HCC patients was analyzed.The impact of DiAcSpm on postoperative recurrence in HCC patients was analyzed.Result The urinary DiAcSpm level of HCC patients was higher than that of healthy persons(P<0.05),but there was no statistical difference in urinary DiAcSpm level between the HCC patients and benignant liver disease patients(P>0.05).There is a certain positive correlation between urinary DiAcSpm and serum alpha-fetoprotein levels in HCC patients(r=0.75,P<0.001).The sensitivity and specificity of DiAcSpm in diagnosing HCC was 0.67 and 0.51,respectively.Based on the cut-off value[0.61μumol/(g·Cre)]of receiver operating characteristic curve,the HCC surgical patients were divided into high DiAcSpm group and low DiAcSpm group.There were no statistical differences in age and gender between the two groups(all P>0.05).The TNM stage and Barcelona clinic liver cancer stage in the high DiAcSpm group were later than those in the low DiAcSpm group in HCC surgical patients,respectively(all P<0.05).Venous invasion was more common in the high DiAcSpm group than in the low DiAcSpm group among HCC surgical patients(P<0.05).There was no statistical difference in the median disease free survival between the high DiAcSpm group and the low DiAcSpm group(P>0.05).Conclusion The level of urinary DiAcSpm in HCC patients is up-regulated and maybe closely related with the occurence and progression of HCC,which is an effective biomarker for early diagnosis and surgical prognosis monitoring in HCC patients.