血清内抑素水平变化在肝癌患者随访中价值

Relationship between preoperation serum endostatin level and its fluctuation after curative removal of hepatocellular carcinoma and tumor recurrence

目的 探讨肝细胞肝癌 (Hepatocellularcarcinoma,HCC)患者根治术前血清内抑素 (Endostatin ,ES)水平及其术后动态变化与HCC预后的关系 ;与甲胎蛋白 (alpha Fato protein ,AFP)比较 ,评价ES作为判断HCC术后复发评价指标的可能性。方法 采集 1999年 3月～ 2 0 0 1年 10月我院4 3例HCC住院手术患者中完全随访的 34例患者术前 2 4h、术后 3及 10d、术后 3及 6个月的 5次血样 ,分别应用ELISA方法和自动发光技术检测血清ES和AFP水平。根据Bus或CT等方法了解患者术后复发情况。结果 34例HCC患者中 11例复发 ,有术前ES水平不高且术后持续较低 ;另外 2 3例未复发患者术前ES血清水平较高 ,手术后 3d血清ES水平总体均值下挫后较快回升 (P <0 0 1)。患者复发后AFP升高 (P <0 0 1) ;但术前AFP水平与术后是否复发无关 (P >0 0 5 )。结论 ES可能参与HCC患者手术后复发的调节 ;血清ES水平作为肝癌患者预后判断指标较AFP对于手术复发具有更高的预测性。

Objective To investigate the relationship between preoperation serum endostatin (ES) level and postoperative fluctuation and recurrence of tumor; and to evaluate the possibility of serum ES as a prognose index of HCC compared with alpha Fetoprotein. Methods ELISA and auto luminescence were used to examine the serum ES and AFP levels respectively. The samples were collected from 34 HCC patients who underwent operation and were followed up till 6 months after curative removal in our hospital from March 1999 to October 2001, and sera had been collected for 5 times: 24 h preoperation, 3 d,10 d, 3 m and 6 m postoperation. B ultrasonic and computer tomography were used to detect recurrence after operation. Results 11 out of the 34 HCC patients recurred with in 6 months of operation, and showed lower serum ES levels during preoperation phase as well as postoperative phase. Whereas, the other 23 cases who had no trace of recurrence showed higher preoperation serum ES levels, and the levels decreased transiently on the 3 d after complete removal of tumor and then elevated sharply( P<0 01 ). Higher serum AFT levels were detected in recurrent patients during 3 or 6 months follow up, but their preoperation levels showed no relation to the recurrence( P>0 05) . Conclusion ES may take part in the regulation of the postoperative recurrence of HCC. Serum ES level is a better forecasting index to recurrence in patients with HCC than that of AFP.