RFA联合热灌注TACE治疗原发性肝癌的临床对照研究  

A clinical controlled study on RFA combined with hyperthermic perfusion TACE in the treatment of primary hepatocellular carcinoma

作　　者：蒋富强 卢伟 杨剑[1] 杨超[1] 杜鹏[1] JIANG Fu-qiang;LU Wei;YANG Jian;YANG Chao;DU Peng(Department of Interventional Medicine,Sixth Medical Center,PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第六医学中心介入医学科,北京100048

出　　处：《肝脏》2021年第10期1087-1090,共4页Chinese Hepatology

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.17299)。

摘　　要：目的了解射频消融(RFA)联合热灌注动脉化疗栓塞(TACE)治疗原发性肝癌(PHC)的疗效。方法选择解放军总医院第六医学中心初治的PHC患者90例,随机分为接受RFA联合热灌注TACE的观察组45例,RFA联合常规TACE的对照组。比较两组患者手术前及手术后3 d时血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT),肿瘤标志物甲胎蛋白(AFP)、糖类抗原199(CA199),血管新生因子缺氧诱导因子-1α(HIF-1α)、血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF),凋亡分子可溶性自杀相关因子(sFas)、可溶性Fas配体(sFasL)的含量。结果两组手术后的血清ALT、AST、GGT、sFas、sFasL含量均增加,血清AFP、CA199、HIF-1α、VEGF、bFGF含量均降低(均P<0.05)。观察组手术后的血清ALT(64.49±12.72)U/L、AST(70.39±11.38)U/L、GGT(128.69±21.28)U/L含量与对照组手术后的血清ALT(66.12±13.27)U/L、AST(71.12±10.93)U/L、GGT(126.78±25.82)U/L含量比较差异均无统计学意义(t=0.584、0.306、0.303,均P>0.05);血清AFP(83.12±13.82)ng/mL、CA199(41.29±8.14)U/L、HIF-1α(313.32±62.39)pg/mL、VEGF(201.25±42.94)pg/mL、bFGF(4.58±0.72)pg/mL含量均低于对照组血清AFP(113.28±19.48)ng/mL、CA199(58.35±9.35)U/L、HIF-1α(394.58±77.24)pg/mL、VEGF(262.44±51.38)pg/mL、bFGF(6.51±0.84)pg/mL含量,血清sFas(59.19±9.44)ng/mL、sFasL(73.12±12.57)ng/mL含量均高于对照组血清sFas(40.27±8.15)ng/mL、sFasL(50.38±9.24)ng/mL含量,差异均有统计学意义(t=8.508、9.199、5.494、6.122、9.249、10.177、9.778,均P<0.05)。结论RFA联合热灌注TACE治疗PHC的癌细胞杀伤作用优于RFA联合常规TACE,抑制血管新生、促进细胞凋亡是介导这一作用的分子机制。Objective To investigate the efficacy of radiofrequency ablation(RFA)combined with transcatheter arterial chemoembolization(TACE)in the treatment of primary hepatocellular carcinoma(HCC).Methods Patients with HCC were randomly divided into observation group(treated with RFA combined with hyperthermic perfusion TACE)and control group(treated with RFA combined with conventional TACE).The serum levels of liver enzymes alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),tumor markers alpha fetoprotein(AFP),carbohydrate antigen 199(CA199),angiogenesis factor hypoxia inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(bFGF),apoptosis molecules soluble factor associated suicide(sFas),soluble Fas ligand(sFasL)were detected before and 3 days after the operation,respectively.Results The serum levels of ALT,AST,GGT,sFas and sFasL increased,while the serum levels of AFP,CA199,HIF-1α,VEGF and bFGF decreased in both groups after operation(P<0.05).The serum levels of ALT(64.49±12.72)U/L,AST(70.39±11.38)U/L,GGT(128.69±21.28)U/L of the observation group were not significantly different from those of the control goup,which the serum levels of ALT(66.12±13.27)U/L,AST(71.12±10.93)U/L,GGT(126.78±25.82)U/L,(P>0.05).The serum levels of AFP(83.12±13.82)ng/mL,CA199(41.29±8.14)U/L,HIF-1α(313.32±62.39)pg/mL,VEGF(201.25±42.94)pg/mL,bFGF(4.58±0.72)pg/mL of the observation group were significantly lower than those of the control group,which the serum levels of AFP(113.28±19.48)ng/mL,CA199(58.35±9.35)U/L,HIF-1α(394.58±77.24)pg/mL,VEGF(262.44±51.38)pg/mL,bFGF(6.51±0.84)pg/mL.The serum levels of sFas(59.19±9.44)ng/mL and sFasL(73.12±12.57)ng/mL in observation group were higher than those in control group,which the serum levels of sFas(40.27±8.15)ng/mL and sFasL(50.38±9.24)ng/mL,(P<0.05).Conclusion The killing effect on tumor cells of RFA combined with hyperthermic perfusion TACE is better than that of RFA combined with convention

关 键 词：原发性肝癌 射频消融 热灌注动脉化疗栓塞 血管新生 凋亡 

分 类 号：R73[医药卫生—肿瘤]