动态监测生化、凝血指标及Wnt3a对肝硬化肝癌病情评估及预后判断的价值  

Value of dynamic monitoring of biochemical and coagulant indexes in disease evaluation and prognosis judgment of liver cancer with liver cirrhosis

作　　者：李淑琴 朱贤勇 章剑坚 Shu-Qin Li;Xian-Yong Zhu;Jian-Jian Zhang(Department of Laboratory Medicine,Linhai Second People Hospital,Linhai 317016,Zhejiang Province,China;Department of Gastroenterology,Linhai Second People Hospital,Linhai 317016,Zhejiang Province,China)

机构地区：[1]临海市第二人民医院检验科,浙江省临海市317016 [2]临海市第二人民医院消化内科,浙江省临海市317016

出　　处：《世界华人消化杂志》2018年第22期1364-1370,共7页World Chinese Journal of Digestology

摘　　要：目的探讨动态监测生化、凝血指标及Wnt3a对肝硬化肝癌病情评估及预后判断的价值.方法选取2012-01/2015-06在临海市第二人民医院诊治的86例肝硬化肝癌患者作为研究对象,根据临床分期不同分为早期组、中期组及晚期组,分别为18例、24例和44例;同时选取同期50例健康体检者作为对照组.采用罗氏501全自动生化分析仪、STAGO全自动凝血分析仪和酶联免疫吸附法分别检测治疗前不同组别生化指标、凝血指标及血清Wnt3a表达水平;出院后进行随访了解其预后,并分析不同组别生化、凝血指标及Wnt3a与预后的关系.结果在血清蛋白和纤维蛋白原的比较上有对照组>早期组>中期组>晚期组;在酶类、凝血酶原时间、活化部分凝血酶时间、凝血酶时间和D-二聚体的比较上有对照组<早期组<中期组<晚期组.经2年随访后,22例生存,64例死亡;其中死亡组在血清蛋白的比较上低于生存组;但在酶类的比较上高于生存组,且差异均具有统计学意义(P<0.05);死亡组在凝血酶原时间、活化部分凝血酶时间、凝血酶时间及D-二聚体及Wnt3a蛋白浓度的比较上高于生存组,但在纤维蛋白原的比较上低于生存组,且差异均具有统计学意义(P<0.05).经单因素及Cox回归分析可知,影响肝硬化肝癌患者预后的危险因素是Child分级、临床分期及Wnt3a蛋白浓度(P<0.05).结论不同临床肝硬化肝癌患者的部分生化指标、凝血指标及Wnt3a蛋白浓度存在不同程度异常,动态检测此类指标可帮助患者有效完成病情评估和预后判断.To assess the value of dynamic monitoring of biochemical and coagulant indexes in the disease evaluation and prognosis judgment of liver cancer with liver cirrhosis. Eighty-six liver cancer patients with liver cirrhosis treated at the Linhai Second People Hospital from January 2012 to June 2015 were selected and divided into early （n = 18）, middle （n = 24）, and late （n = 44） groups according to different clinical stages. Fifty healthy volunteers were selected as a control group. Biochemical indexes, coagulant indexes, and serum Wnt3a in different groups were detected with a Roche 501 automatic biochemical analyzer, an STAGO automatic coagulation analyzer, and by enzyme linked immunosorbent assay, respectively. After discharge, the patients were followed to analyze the relationship of the biochemical, coagulation indexes, and serum Wnt3a concentration with the prognosis. The control group had the highest serum protein and fibrinogen, followed by the early group, middle group, and late group. The control group had the lowest enzymes, prothrombin time, activated partial thromboplastin time, thrombin time, and D-dimer, followed by the early group, middle group, and late group. After two years, 22 cases survived and 64 cases died. Serum protein in the death group was significantly lower than that in the survival group, but the enzymes were significantly higher than those in the survival group （P 〈 0.05）. In the death group, PT, APTT, TT, D-dimer, and serum Wnt3a were significantly higher than those in the survival group, but FIB in the survival group was significantly lower than that in the survivalgroup （P 〈 0.05）. Single-factor analysis and Logistic regression analysis showed that the risk factors affecting the prognosis of liver cirrhosis patients were Child- Pugh classification, clinical stage, and serum Wnt3a concentration （P 〈 0.05）. CONCLUSION There are different degrees of changes in biochemical/ coagulation indexes and serum Wnt3a concentration in patients with different severity

关 键 词：生化指标 凝血指标 肝癌肝硬化 病情评估 预后 

分 类 号：R575.2[医药卫生—消化系统] R735.7[医药卫生—内科学]