肝癌肝移植术前降期中载药微球经动脉化疗栓塞应用效果观察  

Effectiveness of Transarterial Chemoembolization with Drug-Laden Microspheres in the Preoperative Descending Phase of Liver Transplantation for Hepatocellular Carcinoma

作　　者：刘保旺[1] 窦剑[1] 王洋[1] 陈雅洁 刘文鹏[1] 赵鑫[1] 曾强[1] 曹经琳[1] LIU Baowang;DOU Jian;WANG Yang(The Third Hospital of Hebei Medical University,Hebei Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院肝胆外科,河北石家庄050051

出　　处：《河北医学》2023年第7期1183-1188,共6页Hebei Medicine

基　　金：河北青年科技课题,(编号:20190661)。

摘　　要：目的:探究载药微球经动脉化疗栓塞(DEB-TACE)与常规经动脉化疗栓塞术(cTACE)在肝癌肝移植术前降期治疗中的应用价值。方法:选取2015年1月至2022年1月我院74例因肝细胞性肝癌(HCC)行经典原位肝移植患者的临床资料,开展回顾性研究。其中36例肝移植术前行DEB-TACE降期治疗,作为DTACE组,38例肝移植术前行cTACE降期治疗,作为cTACE组。比较两组降期治疗疗效、血清肿瘤标志物[甲胎蛋白(AFP)、糖类抗原199(CA199)、E-钙黏蛋白(EC)]、肝功能指标[天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)]、预后相关标志物[血管内皮生长因子(VEGF)、分泌型蛋白Dickkopf-1(DKK1)、CD24]、不良反应发生率、肝移植术后1年复发转移情况,采用酶联免疫吸附法检测血清VEGF、DKK1、CD24水平。结果:DTACE组降期治疗缓解率(83.33%)与cTACE组(71.05%)对比差异无统计学意义(P>0.05);DTACE组治疗后血清AFP、CA199、EC水平均低于cTACE组,差异具有统计学意义(P<0.05);DTACE组治疗后血清AST、TBIL、ALT水平均低于cTACE组,差异具有统计学意义(P<0.05);DTACE组治疗后血清VEGF、DKK1、CD24水平均低于cTACE组,差异具有统计学意义(P<0.05);DTACE组恶心/呕吐、腹痛、发热、肝脓肿发生率(11.11%、16.67%、69.44%、2.78%)与cTACE组(18.42%、21.05%、76.32%、7.89%)对比差异无统计学意义(P>0.05);DTACE组肝移植术后1年复发率、转移率(5.56%、10.53%)与cTACE组(11.11%、18.42%)对比差异无统计学意义(P>0.05)。结论:肝癌肝移植术前降期治疗中采用DEB-TACE与cTACE均能获得良好治疗效果,其中DEB-TACE能更明显下调血清肿瘤标志物及预后相关标志物水平,在保护肝功能方面具有明显优势。Objective:To investigate the value of drug-laden microsphere transarterial chemoembolization(DEB-TACE)versus conventional transarterial chemoembolization(cTACE)in the preoperative descending treatment of liver cancer liver transplantation.Methods:The clinical data of 74 patients who underwent classical in situ liver transplantation for hepatocellular carcinoma(HCC)in our hospital from January 2015 to January 2022 were collected for a retrospective study.Among them,36 cases underwent DEB-TACE downstaging treatment before liver transplantation as the DTACE group and 38 cases underwent cTACE downstaging treatment before liver transplantation as the cTACE group.The efficacy of the step-down treatment,serum tumor markers[alpha-fetoprotein(AFP),glycoantigen 199(CA199),E-calcine mucin(EC)],liver function indexes[aspartate aminotransferase(AST),total bilirubin(TBIL),alanine aminotransferase(ALT)],prognosis-related markers[vascular endothelial growth factor(VEGF),secretory protein Dickkopf-1(DKK1),CD24],incidence of adverse events,and recurrent metastases 1 year after liver transplantation.Results:There was no statistically significant difference(P>0.05)between the remission rate of the DTACE group on descending treatment(83.33%)and the cTACE group(71.05%);serum AFP,CA199 and EC levels were lower in the DTACE group than in the cTACE group after treatment(P<0.05).Serum AST,TBIL and ALT levels were lower in the DTACE group than in the cTACE group after treatment(P<0.05);serum VEGF,DKK1 and CD24 levels were lower in the DTACE group than in the cTACE group after treatment(P<0.05).There was no statistically significant difference in the incidence of nausea/vomiting,abdominal pain,fever,and liver abscess in the DTACE group(11.11%,16.67%,69.44%,2.78%)compared with the cTACE group(18.42%,21.05%,76.32%,7.89%)(P>0.05);the recurrence rate and metastasis rate 1 year after liver transplantation in the DTACE group(5.56%,10.53%)compared with the cTACE group(11.11%,18.42%)were not statistically significant(P>0.05).Conclusion:Both DEB-TAC

关 键 词：肝细胞性肝癌 肝移植术 降期治疗 载药微球 经动脉化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤]