肝癌患者肝动脉化疗栓塞术后血液指标对栓塞综合征预测价值分析  

Relationship between blood indices and embolism syndrome in the hepatocellular carcinoma patients who underwent TACE

作　　者：臧爽[1] 陈路锋[2] 牛猛[2] 徐阳[2] 徐克[2] 

机构地区：[1]中国医科大学护理学院社区护理教研室,辽宁沈阳110001 [2]中国医科大学附属第一医院介入放射科,辽宁沈阳110001

出　　处：《中华肿瘤防治杂志》2015年第8期623-628,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：辽宁省科学技术计划(2013225021;2013225585)

摘　　要：目的观察肝细胞肝癌患者肝动脉化疗栓塞术（transarterial chemoembolization,TACE）后血液指标的改变与栓塞综合征的发生关系,分析血液指标变化的临床意义。方法回顾性分析2011-10-01-2013-09-30中国医科大学附属第一医院接受治疗的283例TACE术后肝细胞肝癌患者的病例资料,采用单因素以及多因素分析法对患者术中应用碘油的剂量、术前及术后第1次血液检测指标的结果与栓塞综合征的发生情况进行分析。采用结构方程模型分析影响栓塞综合征发生因素之间的关系。使用ROC曲线评估血液指标对判别栓塞综合征的预测性能。结果肝细胞肝癌患者TACE后发生栓塞综合征240例,发生率84.81%（240/283）。发生栓塞综合征的患者应用碘油的剂量（z=-3.675,P〈0.001）、术后白细胞（z=-2.570,P=0.010）、术后中性粒细胞百分比（z=-3.867,P〈0.001）、丙氨酸氨基转移酶（alanine transaminase,ALT）（z=-2.051,P=0.040）显著高于未发生栓塞综合征的患者;术后血清白蛋白（z=-3.342,P=0.001）、总胆红素（z=-1.992,P=0.046）、血清Na＋的指标（t=-2.842,P=0.005）显著低于未发生栓塞综合征患者。中性粒细胞百分比是栓塞综合征发生的危险因素（OR=1.025,95%CI为1.006~1.044,P=0.009）,血清白蛋白是栓塞综合征发生的保护因素（OR=0.979,95%CI为0.961~0.998,P=0.030）。碘油既可以通过直接作用导致患者栓塞综合征的发生,亦可通过中性粒细胞百分比、血清白蛋白、ALT和血清Na＋等血液变化成为栓塞综合征发生的一个间接作用因素。肝癌患者TACE后中性粒细胞百分比、血清白蛋白和ALT对栓塞综合征的发生有预测作用（ROC曲线下的面积分别为0.651、0.673和0.596）。结论肝细胞肝癌患者TACE后中性粒细胞百分比、血清白蛋白、ALT、血清Na＋对患者术后栓塞综合征的发生有较好的预测价值,可作为栓塞综合征发生的评估和预测指标,有助�OBJECTIVE To analyse the correlation of blood index and the incidence of embolism syndrome in pa- tients with hepatocellular carcinoma（HCC） treated with transarterial chemoembolization（TACE） and to evaluate the pre- dictive value of blood index on embolism syndrome. METHODS 283 cases with HCC treated with TACE in the First Hospital of China Medical University between Oct. 1st, 2011 and Sep. 30th, 2013 were included in the study. Clinical pa- rameters,including the dosage of iodine oil used in TACE,the results of blood index test before and after TACE were ana- lyzed by univariate and multivariate analyses to determine the prognostic factors of embolism syndrome after TACE. Structural equation modeling was used to analyse the relationship of the factors correlated with postembolization syn- drome. Receiver operating characteristic curve（ROC） was used to evaluate the prediction performance of blood index on embolism syndrome in patients with HCC treated with TACE. RESULTS Embolism syndrome was observed in 240 patients with HCC after TACE（with the incidence rate of 84.81%0）. Average dose of iodine oil used during TACE, aver- age neutrophil percentage and level of WBC, ALT after TACE in patients with embolism syndrome were significantly higher than that in those without embolism syndrome（z= -3. 675,-3. 867,-2. 570,-2.051 P〈0. 001,0. 010,〈 0. 001,0. 040）. While, average levels of postoperative serum albumin, total bilirubin and Na＋ in patients with embolism syndrome were significantly lower than that in those without embolism syndrome（z/t= -3. 342,-1. 992,-2. 842 P= 0. 001,0. 046,0. 005）. Level of neutrophile granulocyte percentage was demonstrated to be a risk factor for embolism syn- drome（OR= 1. 025, P = 0. 009,95 %CI = 1. 006 ~ 1. 044）, while level of serum albumin was a protective factor （OR = 0. 979,P=0. 030,95GCI=0. 961--0. 998）. Dose of iodine oil used in TACE may be a direct predictive factor for embol- ism syndrome because iodine oil may play an important role in etiol

关 键 词：肝细胞肝癌 肝动脉化疗栓塞术 血液指标 栓塞综合征 

分 类 号：R735.7[医药卫生—肿瘤]