异常凝血酶原(PIVKA-Ⅱ)对TACE治疗肝癌疗效预测  

The application of abnormal prothrombin in predicting the efficacy of TACE in the treatment of hepatocellular carcinoma

作　　者：沈建东[1] 戴锋[1] 王晓维[1] 丁苇[1] 薛红 戚龙菊 付守忠[1] SHEN Jiandong;DAI Feng;WANG Xiaowei;DING Wei;XUE Hong;QI Longju;FU Shouzhong(Department of Vascular Intervention,Affiliated Third Hospital of Nantong University,Nantong Municipal Third People’s Hospital,Nantong,Jiangsu Province 226001,China)

机构地区：[1]南通大学附属第三医院(南通市第三人民医院)介入血管科,江苏226001 [2]南通大学附属第三医院(南通市第三人民医院)肝病科,江苏226001

出　　处：《介入放射学杂志》2020年第1期75-78,共4页Journal of Interventional Radiology

基　　金：江苏省南通市科技局科研基金(MS12017017-2)。

摘　　要：目的探索异常凝血酶原(PIVKA-Ⅱ)在接受TACE的肝癌患者血清中的表达及其临床意义。方法自2013年1月至2016年1月,接受TACE治疗的肝癌患者170例纳入本研究,收集TACE术前及术后1个月血清标本。检测血清中PIVKA-Ⅱ和AFP的表达水平,按照实体肿瘤应答评估标准(RECIST)评估抗肿瘤治疗反应。根据血清AFP和PIVKA-Ⅱ水平在1个月时与术前基础值相比的变化情况,以介入术后1个月随访腹部增强MRI观察肿瘤大小为标准,分析其与肝癌介入术后治疗反应的关系。结果患者AFP在介入治疗术前、术后的变化与治疗反应无明显相关性;介入术前、术后PIVKA-Ⅱ的下降情况与治疗反应正相关;PIVKA-Ⅱ和AFP联合观察,与肿瘤的介入治疗反应相关性更明显。且PIVKA-Ⅱ和AFP两种肿瘤指标无明显相关性。结论PIVKA-Ⅱ水平的降低是肝癌介入栓塞治疗效果和预后判断的良好指标,且与AFP联合判断,效果更确切。Objective To investigate the expression of abnormal prothrombin(vitamin K absence or antagonist-Ⅱ,PIVKA-Ⅱ)in serum of patients with hepatocellular carcinoma(HCC)receiving transcatheter arterial chemoembolization(TACE),and to discuss its clinical significance.Methods A total of 170 HCC patients,who received TACE during the period from January 2013 to January 2016,were enrolled in this study.The serum sampling were collected before TACE and one month after TACE.The expression levels of PIVKA-Ⅱand alpha fetoprotein(AFP)in serum were tested.According to the response evaluation criteria in solid tumors(RECIST),the antitumor response of TACE was graded as complete response(CR),partial response(PR),stable disease(SD)and progressive disease(PD).The serum expression levels of PIVKA-Ⅱand AFP measured at one month after TACE were compared with pre-TACE basic values.Taking the tumor size measured on one-month follow-up abdominal contrast-enhanced MRI as standard,the relationship between tumor size and HCC response to TACE was analyzed.Results No significant correlation existed between the post-TACE changes in AFP level and the therapeutic response.The post-TACE decreased degree of PIVKA-Ⅱwas positively correlated with therapeutic response(CR/PR).Combination consideration of PIVKA-Ⅱand AFP bore more close relationship with therapeutic response,and there was no significant correlation between PIVKA-Ⅱand AFP.Conclusion The post-TACE decrease in serum PIVKA-Ⅱis a useful index in predicting the curative effect of TACE for HCC as well as in predicting the prognosis of patient,and the predicting result will be more accurate if AFP level is simultaneously taken into consideration.

关 键 词：肝细胞肝癌 HCC 异常凝血酶原 PIVKA-Ⅱ 预后 

分 类 号：R735.7[医药卫生—肿瘤]