术前胆红素及氨基转移酶水平在胃癌预后中的临床意义  

Preoperative Blood Bilirubin and Aminotransferase Levels Predict Prognosis of Gastric Cancer Patients

作　　者：李军杰[1] 刘斌正 阴慧慧[2] 张文杰[2] 

机构地区：[1]江苏省常州市德安医院内科,常州213001 [2]新疆石河子大学医学院病理学系,石河子832002

出　　处：《华中科技大学学报（医学版）》2016年第5期504-508,518,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家科技部科技支撑计划资助项目(No.2009BAI82B02)

摘　　要：目的探讨胃癌患者术前血中总胆红素(TBIL)、直接胆红素(DBIL)和间接胆红素(IBIL)水平及天门冬氨酸氨基转移酶(AST)和丙氨酸氨基转移酶(ALT)水平与临床及病理特征的相关性,及其对生存预后的影响。方法收集302例汉族胃癌患者临床资料并随访118个月;术前常规检测血中胆红素及氨基转移酶水平;应用Spearman法分析胃癌患者术前BMI、DBIL、AST与临床及病理特征之间的相关性,应用Kaplan-Meier法和Cox单因素和多因素生存风险回归分析年龄、BMI、肿瘤临床分期、血中DBIL和AST水平与胃癌患者生存预后的关系。结果 1影响胃癌患者生存的独立危险因素有:高龄(P=0.036)、细胞分化程度低(P=0.011)、胃癌晚期Ⅲ+Ⅳ(P<0.01)、胃癌肝转移(P=0.014)、BMI≤23.9kg/m^2(P=0.015)及AST高水平(女性AST>35U/L;男性AST>40U/L)(P=0.029)。2AST水平与DBIL水平呈正相关(r=0.194,P<0.05);Kaplan-Meier生存分析显示DBIL高水平患者预后较差(P=0.008);AST与胃癌患者预后呈负相关关系,即AST水平越高,预后越差(P=0.008)。结论首次发现术前AST水平影响胃癌患者生存并验证了DBIL水平与生存有关,藉此提出,术前AST及DBIL高水平可作为"胃癌肝转移术前预警"的假说。参考术前AST和DBIL水平及其它辅助检查有助于选择胃癌最佳个体化治疗策略。Objective To examine the association of the levels of blood total bilirubin（TBIL）,direct bilirubin（DBIL）,indirect bilirubin（IBIL）,aspartate aminotransferase（AST）and alanine aminotransferase（ALT）with clinical and pathological features of patients with gastric cancer（GC）and the effect of the changes of these parameters on the patient prognosis.Methods Clinical data of 302 Han Chinese who were diagnosed as having GC and followed up for 118 months were collected.The levels of blood bilirubins and aminotransferases were routinely detected before the operation.Spearman rank correlation analysis was used to analyze the association of pre-operative BMI,DBIL,and AST with clinical/pathologic characteristics in GC patients.KaplanMeier analysis and Cox univariate and multivariate regression analyses were adopted to evaluate the correlations between age,BMI,clinical staging,DBIL,or AST and the survival prognosis of GC patients.Results ①The independent factors that were found to affect the survival of GC patients were as follows：old age（P=0.036）,poor cell differentiation（P=0.011）,late TNM stage（Ⅲ＋Ⅳ）（P〈0.01）,BMI≤23.9kg/m^2（P=0.015）,liver metastasis（P=0.014）and high levels of AST（〉35U/L in females and 〉40U/L in males）（P=0.029）.②Levels of AST and DBIL were positively correlated（r=0.194,P〈0.05）.KaplanMeier analyses showed that GC patients with high DBIL levels had poor survival（P=0.008）;AST levels were negatively correlated with the survival of patients（P=0.008）.The higher the AST levels were,the poorer the prognosis of the patients.Conclusion To our knowledge,for the first time,it was demonstrated that pre-operative AST levels influence the survival of GC patients,and DBIL levels are associated with the patient prognosis.Our findings led us to hypothesize that preoperatively increased levels of AST and DBIL may serve as a pre-operative warning for liver metastasis of gastric cancer.The optimal individualized therapeutic strategy can be deter

关 键 词：胃癌 直接胆红素 天门冬氨酸氨基转移酶 生存预后 术前预后评估 

分 类 号：R657.3[医药卫生—外科学]