乙型肝炎病毒感染相关肝癌患者术前异常凝血酶原和甲胎蛋白水平对其预后影响的研究  

Effect of PIVKA-Ⅱ and AFP levels on the prognosis of patients with HBV infection-related hepatocellular carcinoma

作　　者：姚明解[1] 陈华楠 钱相君 许强[1] 陈香梅[1] 吕全军[2] 张玲 鲁凤民[1] YAO Ming-jie;CHEN Hua-nan;QIAN Xiang-jun;XU Qiang;CHEN Xiang-mei;LYU Quan-jun;ZHANG Ling;LU Feng-min(Department of Pathogenic Biology and Infectious Diseases,School of Basic Medical Sciences,Peking University,Beijing 100191)

机构地区：[1]北京大学基础医学院病原生物学系暨感染病中心,北京100191 [2]郑州大学公共卫生学院,河南郑州450001 [3]郑州大学附属肿瘤医院肝胆胰外科,河南郑州450008

出　　处：《中国实用内科杂志》2019年第7期640-643,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家十三五“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项基金(2017ZX10302201,2017ZX10202203);国家自然科学基金(81372603,81471938);中国博士后科学基金(2017M620544,2018T110014);北京市科学技术委员会资助项目(Z161100000116047)

摘　　要：目的探讨术前异常凝血酶原(PIVKA-Ⅱ)和甲胎蛋白(AFP)水平对进行手术切除的乙型肝炎病毒(HBV)感染相关肝癌患者生存预后的影响。方法收集2009—2013年间在郑州大学附属肿瘤医院进行手术切除的,临床资料、实验室检测数据及随访数据完整的HBV感染相关肝细胞癌患者107例。化学发光法定量测定术前冻存的血清PIVKA-Ⅱ浓度。采用Kaplan-Meier绘制生存曲线,Cox比例风险模型分析影响患者生存预后的因素。结果Kaplan-Meier生存曲线结果显示,高PIVKA-Ⅱ水平患者的1、2、3年生存率分别为56%、28%及16%,低于低PIVKA-Ⅱ水平患者的1、2、3年生存率73%、54%及46%,差异有统计学意义(P=0.002);高AFP水平患者的1、2、3年生存率分别为58%、35%及25%,低AFP水平患者的1、2、3年生存率分别为83%、63%及51%,差异有统计学意义(P=0.006)。多因素结果显示,术前高PIVKA-Ⅱ水平、高AFP水平、存在门静脉癌栓及包膜不完整是HBV感染相关肝癌患者预后的独立危险因素,HR(95%CI)分别为1.99(1.15~3.45)、2.03(1.10~3.76)、2.72(1.53~4.83)、2.07(1.07~4.00),且随着该4项危险因素个数的增加,预后越差。结论术前PIVKA-II和AFP水平与慢性HBV感染肝细胞癌患者的预后有关,术前高PIVKA-II、AFP水平的患者预后差。Objective To evluated the prognostic potential of preoperative PIVKA-Ⅱ and AFP to the patients of HBV infection-related hepatocellular carcinoma(HCC) after radical resection. Methods Chronic HBV infection-related HCC patients who undergone resection in the Affiliated Cancer Hospital of Zhengzhou University from 2009 to 2013 with competed data of clinical information,laboratory results and follow-up records were enrolled our study. Finaly, a total of 107 subjects entered our research. PIVKA-Ⅱ was quantitatively measured by Chemiluminescence methods. Kaplan-Meier survival analysis and the Cox proportional hazards model were used to analyze the factors which can affect patient’s post surgery survival. Results Kaplan-Meier survival curve analysis showed that the 1-,2-,3-year survival rate of the patients with high PIVKA-Ⅱ level were 56%, 28% and 16%, respectively, much poor than that of patients with low PIVKA-Ⅱ level, the 1-,2-,3-year survival rate for the latter were 73%, 54% and 46%, respectively(P = 0.002). The 1-,2-,3-year survival rates for patients with high AFP levels were 58%, 35% and 25%, respectively, and the the 1-,2-,3-year survival rates for patients with low AFP levels were 83%, 63% and 51%, respectively(P = 0.006). Multivariate factor results showed that high PIVKA-Ⅱ levels, high AFP levels, the presence of portal vein tumor thrombus and incomplete capsular were independent risk factors for prognosis,HR(95% CI) were 1.99(1.15-3.45), 2.03(110-3.76), 2.72(1.53-4.83) and 2.07(1.07-4.00), respectively. In addition, the prognosis would got worse with the superposition of four independent risk factors. Conclusion Preoperative PIVKA-Ⅱ and AFP levels are associated with HCC patients’ s poor post surgery prognosis.

关 键 词：异常凝血酶原 甲胎蛋白 肝细胞癌 生存预后 

分 类 号：R735.7[医药卫生—肿瘤]