血清异常凝血酶原在肝细胞癌诊疗中的意义  

Value of serum des-γ-carboxy-prothrombin in the diagnosis and treatment of hepatocellular carcinoma

作　　者：孙玉[1] 张洪海[1] 袁春旺[1] 扈彩霞[1] 刘博君[1] 崔石昌[1] 钱智玲[1] 张英华[1] 张永宏[1] 郑加生[1] SUN Yu, ZHANG Honghai, YUAN Chunwang, et al.(Minimally Invasive Interventional Center of Oncology, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学附属北京佑安医院肿瘤微创介入中心,北京100069

出　　处：《临床肝胆病杂志》2018年第10期2148-2152,共5页Journal of Clinical Hepatology

基　　金：国家自然科学基金资助项目(81472328)

摘　　要：目的研究血清异常凝血酶原(DCP)在肝细胞癌(HCC)患者中的表达水平及其与肿瘤性状、病理及临床特征之间的关系。方法选择2016年1月-2018年3月在首都医科大学附属北京佑安医院住院治疗并经外科手术切除组织病理确诊的肝细胞癌患者80例,检测患者术前血清DCP及AFP水平并进行相关性分析,分析患者的临床信息、影像学、病理学结果与DCP水平的关系。计量资料两组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验,两组样本的相关性检验采用Spearman相关分析。结果 HCC患者血清AFP与DCP水平无明显相关性(r=0. 141,P>0. 05); HCC患者血清DCP水平与肿瘤直径之间显著相关(r=0. 563,P <0. 01);肝内多发肿瘤、合并远处转移、存在肉眼或微观血管侵犯的HCC患者血清DCP水平分别高于肝内单发肿瘤(Z=-5. 484,P <0. 001)、无远处转移(Z=-4. 569,P <0. 001)、无肉眼血管侵犯(Z=-3. 713,P <0. 001)或微观血管侵犯(Z=-3. 244,P=0. 001)患者;按国内分期标准,Ⅰ期HCC患者血清DCP浓度明显低于Ⅱ期及Ⅲ期患者(P值分别为0. 005、<0. 001),而Ⅱ期与Ⅲ期患者间血清DCP水平差异无统计学意义(P=0. 477)。病理Edmondson-Steiner(ES)Ⅱ级及Ⅲ级患者血清DCP水平均低于ESⅣ级患者(P值分别为<0. 001、0. 002),而Ⅱ级与Ⅲ级患者间血清DCP水平差异无统计学意义(P=0. 133)。结论 HCC患者血清DCP水平与肿瘤数量、大小、临床分期、远处转移、血管侵犯、病理分级相关。Objective To investigate the expression of des-γ-carboxy-prothrombin（ DCP） in serum in hepatocellular carcinoma（ HCC） patients and its association with tumor properties,pathology,and clinical features. Methods A total of 80 patients who were hospitalized and treated in our hospital from January 2016 to March 2018 and were diagnosed with HCC by pathology after surgical resection were enrolled. The serum levels of DCP and alpha-fetoprotein（ AFP） were measured before surgery and the correlation between them was analyzed. The association of DCP level with clinical data,imaging findings,and pathological results was analyzed. Mann-Whitney U test was used for comparison of continuous data between two groups,Kruskal-Wallis H test was used for comparison between multiple groups,and the Mann-Whitney U test was used for further comparison between two groups; the Spearman correlation analysis was performed to investigate correlation. Results There was no significant correlation between the serum levels of AFP and DCP in HCC patients（ r = 0. 141,P〉0. 05）. In HCC patients,serum DCP level was significantly correlated with tumor diameter（ r = 0. 563,P〈0. 01）. The HCC patients with intrahepatic multiple tumors,distant metastasis,or macrovascular or microvascular invasion had a significantly higher serum DCP level than those with intrahepatic single tumor（ Z =-5. 484,P〈0. 001） or without distant metastasis（ Z =-4. 569,P〈0. 001）,macrovascular invasion（ Z =-3. 713,P〈0. 001）,or microvascular invasion（ Z =-3. 244,P = 0. 001）. According to the staging criteria in China,the patients with stage Ⅰ HCC had a significantly lower serum DCP level than those with stage Ⅱ/Ⅲ HCC（ P = 0. 005 and P〈0. 001）,while there was no significant difference in serum DCP level between the patients with stage Ⅱ HCC and those with stage Ⅲ HCC（ P = 0. 477）.The patients with Edmondson-Steiner grade Ⅱ/Ⅲ HCC had a significantly lower serum DCP level than those with Edmondson-Steiner grade IV HC

关 键 词：癌 肝细胞 异常凝血酶原 甲胎蛋白类 

分 类 号：R735.7[医药卫生—肿瘤]