腹腔镜精准肝切除对原发性肝癌患者MMP、VEGF、sPD-1的影响  

Effect of Laparoscopic Precise Hepatectomy on MMP Protease,Vascular Endothelial Growth Factor and Soluble PD-1 in Primary Liver Cancer Patients

作　　者：付宁[1] 沙莎[2] Fu Ning;Sha Sha(Hepatobiliary Surgery,the First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China;Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院肝胆外科,成都610500 [2]成都医学院,成都610500

出　　处：《成都医学院学报》2018年第5期589-593,共5页Journal of Chengdu Medical College

摘　　要：目的探讨腹腔镜精准肝切除(laparoscope precise hepatectomy,LPH)对原发性肝癌(primary liver cancer,PLC)患者基质金属蛋白酶(MMP)、血管内皮生长因子(VEGF)、可溶性PD-1(sPD-1)的影响。方法选取2014年1月至2016年12月于成都医学院第一附属医院行手术治疗的PLC患者120例为研究对象,按照随机数字表法分为试验组和对照组,各60例。对照组患者行非规则性肝切除,试验组患者行LPH。观察两组患者手术情况及术后恢复指标;两组患者术前、术后7dMMP-2、MMP-9及VEGF、sPD-1水平;T细胞(T)、辅助性T细胞(Th)、抑制性T细胞(Ts)、细胞因子诱导的杀伤细胞(CIK)、自然杀伤细胞(NK)等免疫因子水平;术后并发症发生情况、术后1年复发情况等指标。结果与对照组比较,试验组患者术中出血量、输血量、引流量、排气时间及住院时间均较少,肝门阻断时间、手术时间均较长,差异有统计学意义(P<0.05);术后7d,两组患者MMP-2、MMP-9、VEGF指标比较,差异无统计学意义(P>0.05);术后7d,试验组患者sPD-1水平高于对照组,差异有统计学意义(P<0.05);术后7d,试验组患者T、Th、CIK、NK水平高于对照组,Ts水平低于对照组,差异均有统计学意义(P<0.05);试验组患者术后并发症发生率为5.00%(3/60),低于对照组的18.33%(11/60),差异有统计学意义(P<0.05)。试验组与对照组患者术后1年复发率(23.33%vs 28.33%)比较,差异无统计学意义(P>0.05)。结论LPH治疗PLC可完整切除病灶,维护残肝功能,并有效降低MMP-2、MMP-9及VEGF水平,且对机体扰动小,有利于患者免疫机制的恢复及疾病康复。Objective To study the effects of laparoscopic precise hepatectomy （LPH） on MMP, VEGF and SPD-1 in patients with primary liver cancer （PLC）. Methods A total of 120 PLC patients who underwent operation in our hospital from January 2014 to December 2016 were enrolled in this study. The patients were divided into the test group （n=60） and control group （n=60） according to random number table method. The control group underwent irregular hepatectomy and test group were given LPH. The levels of MMP-2, MMP-9, VEGF, sPD-1, T, Th, Ts, CIK, NK and other immune factors, postoperative complications, postoperative recurrence and survival were observed. Results As compared with the control group, the blood loss, blood transfusion and drainage were lower and exhaust time and hospitalization time was shorter in the test group, whereas the time of hepatic hilus occlusion and operation were longer in test group （ P 〈0.05）. There was no significant difference in MMP-2, MMP-9 and VEGF between the two groups 7 days after operation （ P 〉0.05）. The levels of SPD-1 in the test group was higher than that in control group 7 days after operation （ P 〈0.05）. In addition, 7 days after operation, T, Th, Ts, CIK and NK in the test group were higher than those in the control group, and ts was lower than that in the control group （ P 〈0.05）. The incidence of postoperative complications in test group （5.00%） was lower than that in the control group （18.33%） （ P 〈0.05）. There was no significant difference in recurrence rate （23.33% vs 28.33%） between the test group and control group （ P 〉0.05）. Conclusion LPH is minimally invasive for PLC treatment, which can completely remove lesions with, maintain residual liver function as well as effectively reduce MMP-2, MMP-9 and VEGF levels, thus is conducive to immune recovery and patient rehabilitation.

关 键 词：腹腔镜精准肝切除 原发性肝癌 基质金属蛋白酶 血管内皮生长因子 可溶性PD-1 免疫因子 

分 类 号：R735.7[医药卫生—肿瘤]