C反应蛋白及直接胆红素作为肝细胞癌合并大血管侵袭的早期诊断指标  

C-reactive protein and direct bilirubin as the early diagnostic indicators of primary hepatocellular carcinoma combined with macrovascular invasion

作　　者：蔡春仙 付琪备 雷宇[1] 陈压西[1] 杨萍[2] 周智[1] Cai Chunxian;Fu Qibei;Lei Yu;Chen Yaxi;Yang Ping;Zhou Zhi(Department of Infectious Diseases,The Second Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China;Centre for Lipid Research,Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第二医院感染科,400010 [2]重庆医科大学脂质研究中心,400016

出　　处：《中华肝脏病杂志》2020年第8期692-698,共7页Chinese Journal of Hepatology

基　　金：国家自然科学基金(81400786)。

摘　　要：目的为临床肝细胞癌(HCC)合并大血管侵袭患者提供早期诊断的生物标志物。方法回顾性分析2012—2019年重庆医科大学附属第二医院经组织病理检查诊断为HCC的180例患者临床资料。进行HCC患者发生大血管侵袭的影响因素分析,并进行受试者工作特征曲线(ROC曲线)分析其评估灵敏度和特异度。结果血清C反应蛋白(CRP)水平与HCC患者多项临床特征,包括最大肿瘤直径、肿瘤数目和大血管侵袭等具有显著相关性。进一步分析影响HCC患者大血管侵袭的危险因素发现:血清直接胆红素及CRP均可作为独立危险因素,优势比分别是1.747(95%可信区间1.119~2.728,P=0.014)、2.376(95%可信区间1.495~3.775,P<0.001)。进行ROC曲线分析表明,血清CRP、直接胆红素及二者联合对于肝癌合并大血管侵袭有一定的诊断价值,曲线下的面积分别是0.724、0.668、0.743,敏感度分别是79.1%、70.1%、79.1%,特异度分别是61.9%、62.8%、67.3%。结论CRP联合直接胆红素可作为诊断HCC合并大血管侵袭的早期血清标志物,在诊断治疗及预防HCC大血管侵袭中具有重要的临床价值。Objective To explore the early clinical diagnostic indicators in patients with primary hepatocellular carcinoma(HCC)combined with macrovascular invasion.Methods The clinical data of 180 cases of HCC diagnosed by histopathology examination in the Second Affiliated Hospital of Chongqing Medical University from 2012 to 2019 were retrospectively analyzed.The factors influencing the development of macrovascular invasion in HCC patients were analyzed.The receiver operating characteristic curve(ROC curve)was used to evaluate the sensitivity and specificity.Results Serum C-reactive protein(CRP)level was significantly correlated with various clinical characteristics of HCC patients,including the maximum tumor diameter,tumor number,and macrovascular invasion.Further analysis of the risk factors showed that serum direct bilirubin and CRP were independent risk factors for macrovascular invasion in HCC patients,with odds ratios of 1.747(95%CI 1.119-2.728,P=0.014)and 2.376(95%CI 1.495-3.775,P<0.001).ROC curve analysis showed that serum CRP,direct bilirubin,and the combination of the both had certain diagnostic value for hepatocellular carcinoma combined with macrovascular invasion.The area under the curve,sensitivity and specificity was 0.724,0.668,0.743,79.1%,70.1%,79.1%,and 61.9%,62.8%,67.3%,respectively.Conclusion The combination of CRP with direct bilirubin can be used as an important clinical diagnostic indicator for early diagnosis and prevention of hepatocellular carcinoma combined with macrovascular invasion.

关 键 词：肝细胞癌 C反应蛋白 直接胆红素 大血管侵袭 早期诊断 

分 类 号：R735.7[医药卫生—肿瘤]