外周血T淋巴细胞CD4表达水平在肝移植肝癌复发诊断及预后评估中的价值  

Diagnostic and prognostic value of peripheral blood CD4+T lymphocytes for hepatocellular carcinoma recurrence after liver transplantation

作　　者：刘宁[1] 张权[2] 于艳华[1] 陈德喜 娄金丽[1] Ning Liu;Quan Zhang;Yanhua Yu;Dexi Chen;Jinli Lou(Department of Clinical Laboratory,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Department of Science and Technology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China;Beijing Institute of Hepatology,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院检验科,北京100069 [2]首都医科大学附属北京佑安医院科研处,北京100069 [3]北京市肝病研究所,北京100069

出　　处：《中华检验医学杂志》2023年第1期68-73,共6页Chinese Journal of Laboratory Medicine

基　　金：北京市科技计划(Z201100007920011);首都卫生发展科研专项公共卫生项目(首发2021-1G-4302,首发2021-1G-4301)。

摘　　要：目的探讨外周血T淋巴细胞CD4表达水平在肝移植肝癌复发患者诊断与预后评估中的价值。方法回顾性分析2014年1月至2016年12月在北京佑安医院肝移植中心进行肝移植治疗和5年随访的50例肝癌患者的临床资料与实验室资料,比较肝移植肝癌复发组(29例)和未复发组(21例)患者肝功能、血常规、肿瘤标志物、外周血T淋巴细胞分类等实验室指标及5年生存情况,用Spearman相关性分析各临床指标与肝移植肝癌复发的相关性,采用受试者工作特征(ROC)曲线分析T淋巴细胞CD4表达水平对肝移植肝癌复发的诊断效能,采用Kaplan-Meier生存曲线比较不同CD4表达水平患者的生存差异。结果与肝移植肝癌未复发组比较,复发组丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、白蛋白、淋巴细胞、甲胎蛋白、维生素K缺乏或拮抗剂诱导的蛋白质Ⅱ、CD3+、CD4+、CD8+T表达水平差异有统计学意义(P均<0.05);肝移植肝癌复发组复发时间为13.0(6.0,24.0)个月,在5年随访中全部死亡,未复发组无死亡;复发组生存时间为18.0(9.0,36.0)个月,明显低于肝移植肝癌未复发组的60.0(60.0,60.0)个月(P<0.05)。与未复发组比较,复发组的CD3+、CD4+、CD8+T淋巴细胞的表达水平较低(P均<0.05)。Spearman多因素相关性分析显示,肝移植肝癌复发与CD3+、CD4+、CD8+T淋巴细胞的表达水平呈负相关(r=-0.43、-0.38、-0.44,P均<0.05);ROC曲线显示,CD4+T淋巴细胞对肝移植肝癌复发诊断的曲线下面积为0.755(95%CI 0.621~0.888),取最佳截断值265.50个/μl时,诊断特异度为100%,敏感度为48.30%。Kaplan-Meier生存曲线分析显示,CD4≤265.50个/μl患者的生存时间低于CD4>265.50个/μl组[15.0(10.0,36.8)个月比53.0(19.5,60.0)个月,P<0.05]。结论外周血T淋巴细胞CD4表达水平与肝移植肝癌复发呈负相关,CD4+T淋巴细胞取265.50个/μl时对肝移植肝癌复发的临床诊断与预后评估具有较高的价值。Objective To investigate the clinical value of peripheral blood T lymphocytes in the diagnosis and prognosis of patients with hepatocellular carcinoma(HCC)recurrence after liver transplantation.Methods The clinical and laboratory data of 50 HCC patients,who received liver transplantation and were followed up in the Liver transplantation Center of Beijing Youan Hospital from January 2014 to December 2016,were retrospectively analyzed.The differences on clinical laboratory indicators and five-year survival were compared between HCC recurrence group(n=29)and non-recurrence group(n=21).Spearman correlate analysis was used to analyze the correlation between clinical laboratory indicators and HCC recurrence after liver transplantation.Receiver operator characteristic(ROC)curve was used to analyze the diagnostic value of CD4+T lymphocytes in HCC recurrence after liver transplantation.Kaplan-Meier survival curve was used to compare the survival time of patients with different CD4+T lymphocytes levels post liver transplantation.Results Compared to non-recurrence group,the level of alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,albumin,lymphocytes,alpha-fetoprotein,protein induced by vitamin K deficiency or antagonist-Ⅱ,CD3+,CD4+and CD8+T lymphocytes were significantly different(all P<0.05).The median recurrence time after liver transplantation was 13.0(6.0,24.0)months,and the mortality rate was 100%.The 5-year mortality rate was 0 in the non-recurrence group.During 5-year follow-up,the median survival time of patients in the HCC recurrence group was 18.0(9.0,36.0)months,which was significantly lower than that of non-recurrence group[60.0(60.0,60.0)months,(P<0.05)].Compared with non-recurrence group,the CD3+,CD4+,and CD8+T lymphocytes were significantly lower in the recurrence group(all P<0.05).Spearman correlate analysis showed that HCC recurrence after liver transplantation was negatively correlated with the CD3+,CD8+and CD4+T lymphocytes(r=-0.43,-0.38,-0.44,all P<0.05).ROC analysis showed t

关 键 词：肝移植 肿瘤CD4阳性T淋巴细胞 诊断 预后 

分 类 号：R735.7[医药卫生—肿瘤]