肝癌患者患癌前后的血清学指标水平对比研究

Comparative study of serum indexes before and after cancer incidence in patients with liver cancer

目的探讨肝癌患者患癌前后血清学指标水平的变化,以尽早在肝炎肝硬化患者中筛选出易发肝癌的高危人群。方法选择2006年1月至2013年6月我院随访的肝炎肝硬化相关原发性肝癌患者173例,均有完善的肝癌及患癌前肝硬化阶段资料,其中原发性肝癌Ⅰ期66例,Ⅱ期47例,Ⅲ期40例,Ⅳ期20例。收集患者肝功能等血清学指标,分别比较Ⅰ、Ⅱ、Ⅲ、Ⅳ期肝癌患者各血清学指标在患癌前和肝癌后的差异。结果肝癌Ⅰ期患者肝癌后DNA(500 copies/m L vs 47 350 copies/m L)、谷丙转氨酶(ALT)(36.60 U/L vs 46.25 U/L)、谷草转氨酶(AST)(40.35 U/L vs 52.30 U/L)、总胆红素(TBIL)(23.10μmol/L vs 30.63μmol/L)、直接胆红素(DBIL)(7.90μmol/L vs 11.00μmol/L)、谷氨酸转肽酶(GGT)(42.45 U/L vs 52.90 U/L)水平比肝癌前降低,白蛋白(ALB)[(33.86±6.7)g/L vs(31.43±6.78)U/L)]、胆碱酯酶(CHE)(3 745 U/L vs 2 961 U/L)比肝癌前升高,差异均有统计学意义(P<0.05);肝癌Ⅱ期患者患癌后DNA水平比肝癌前低(672 copies/m L vs 71 450 copies/m L),甲胎蛋白(AFP)水平比肝癌前高(48.9 ng/m L vs 15.92 ng/m L),差异均有统计学意义(P<0.05);Ⅲ期肝癌患者患癌后AFP(83.13 ng/m L vs 10.76 ng/m L)、AST(68.9 U/L vs 41.5 U/L)、TBIL(38.10μmol/L vs 26.00μmol/L)、DBIL(14.05μmol/L vs 9.20μmol/L)及GGT(62.8 U/L vs 43.60 U/L)水平均高于肝癌前,差异有统计学意义(P<0.05);Ⅳ期肝癌患者患癌后DNA水平比肝癌前低(654.51 copies/m L vs 7 200 copies/m L),AFP(210.55 ng/m L vs 7.06 ng/m L)、ALT(54.70 U/L vs 37.35 U/L)、AST[106.70 U/L vs(70.13±50.50)U/L]、Tbil[58.10μmol/L vs(31.59±14.3)μmol/L]、Dbil[23μmol/L vs(12.41±6.85)μmol/L]及GGT(100.30 U/L vs 41.20 U/L)水平均高于肝癌前,差异具有统计学意义(P<0.05)。结论 DNA、AFP、ALT、AST、TBIL、DBIL、GGT等指标的变化对肝炎肝硬化患者预测肝癌有一定指导意义。

Objective To investigate the changes of serum indexes of cancer patients before and after liver cancer incidence, so as to screen the high-risk population of hepatocellular carcinoma(HCC) in patients with cirrhosis as early as possible. Methods A total of 173 patients, who were diagnosed as primary hepatic carcinoma related to liver cirrhosis were selected, followed up in our hospital from January 2006 to June 2013. There were perfect staging data for liver cancer and liver cirrhosis, of which 66 cases of stageⅠliver cancer, 47 cases of stageⅡ, 40 cases of stage Ⅲ, 20 cases of stage Ⅳ. The serological indexes in hepatic carcinoma patients of stageⅠ, Ⅱ, Ⅲ, Ⅳ before and after liver cancer were collected and compared. Results After liver cancer incidence, The levels of DNA(500 copies/m L vs 47 350 copies/m L), alanine aminotransferase(ALT)(36.60 U/L vs 46.25 U/L), aspartate aminotransferase(AST)(40.35 U/L vs 52.30 U/L), total bilirubin(TBIL)(23.10 μmol/L vs 30.63 μmol/L), direct bilirubin(DBIL)(7.90 μmol/L vs 11.00 μmol/L), γ-glutamyl transferase(GGT)(42.45 U/L vs 52.90 U/L) in patients of stageⅠliver cancer were significantly lower than before liver cancer incidence(P<0.05). The levels of albumin(ALB) cholinesterase(CHE) were significantly higher than before liver cancer incidence(P<0.05). DNA level(672 copies/m L vs 71 450 copies/m L) in stageⅡliver cancer was significantly lower than before liver cancer incidence(P<0.05). Alpha-fetoprotein(AFP) level(48.90 ng/m L vs 15.92 ng/m L) was significantly higher than before liver cancer incidence(P<0.05). The levels of AFP(83.13 ng/m L vs 10.76 ng/m L), AST(68.90 U/L vs 41.50 U/L), TBIL(38.10 μmol/L vs 26.00 μmol/L), DBIL(14.05 μmol/L vs 9.20 μmol/L) and GGT(62.80 U/L vs 43.6 U/L) levels of stage ⅢLiver cancer were higher than that of before liver cancer incidence(P<0.05). DNA(654.51 copies/m L vs 7 200 copies/m L)level of stage Ⅳ liver cancer was significantly lower than that of before liver cancer incidence(P<0.05). The levels of AFP(210.55 ng/m L vs 7.06 ng/m L), ALT(54.70 U/L vs 37.35 U/L), AST [106.70 U/L vs(70.13±50.50) U/L], TBIL [58.10 μmol/L vs(31.59±14.30) μmol/L], DBIL [23 μmol/L vs(12.41±6.85) μmol/L] and GGT(100.30 U/L vs 41.20 U/L) were significantly higher than that of before liver cancer incidence(P<0.05). Conclusion The index changes of DNA, AFP, ALT, AST,TBIL, DBIL and GGT have some guiding significance for the prediction of liver cancer in patients with hepatitis cirrhosis.