术前血清热休克蛋白90α水平联合预后营养指数对肝细胞癌经动脉化疗栓塞后的预后预测价值  

Predictive value of preoperative serum heat shock protein 90αlevel in combination with prognostic nutritional index for hepatocellular carcinoma after transarterial chemoembolization

作　　者：陈培升[1] 林泽毅 覃柯璋 邓钰城 CHEN Peisheng;LIN Zeyi;QIN Kezhang;DENG Yucheng(Department of Hepatobiliary Pancreatic Surgery,Guigang People’s Hospital,Guigang,Guangxi Zhuang Autonomous Region 537100,P.R.China)

机构地区：[1]贵港市人民医院肝胆胰外科,广西壮族自治区贵港537100

出　　处：《中国普外基础与临床杂志》2025年第3期319-324,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：广西自然科学基金项目(项目编号:2024GXNSFAA10025)。

摘　　要：目的探讨术前血清热休克蛋白90α(heat shock protein 90α,HSP90α)水平联合预后营养指数(prognostic nutritional index,PNI)对肝细胞癌(hepatocellular carcinoma,HCC)经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗后的预后预测价值。方法选取2022年1月至2023年6月期间在贵港市人民医院经组织病理检查证实为拟行TACE治疗的HCC患者作为观察组,同期体检健康者作为对照组。采集HCC患者TACE术前1 d和体检健康者体检时的3 mL空腹外周静脉血检测HSP90α和白蛋白水平以及淋巴细胞计数,同时计算PNI[PNI=白蛋白(g/L)+5×淋巴细胞计数(×10^(9)/L)]。观察TACE治疗后1年内的临床结局(肿瘤进展或死亡),无肿瘤进展或死亡者定义为预后良好,反之则定义为预后不良。采用多因素非条件logistic回归分析影响HCC患者预后不良的风险因素,采用受试者操作特征曲线下面积评价血清HSP90α水平联合PNI区分TACE治疗后的预后价值。结果本研究中观察组178例、对照组100例,观察组血清HSP90α水平(μg/L)高于对照组(96.40±33.57比52.19±22.13,t=3.191,P<0.001),而PNI值低于对照组(43.70±5.24比56.46±6.86,t=-16.144,P<0.001);TACE治疗后1年内预后不良者70例、预后良好者108例,预后不良患者的血清HSP90α水平(μg/L)高于预后良好患者(117.33±29.48比82.83±28.84,t=7.726,P<0.001),而PNI低于对照组(40.49±4.18比45.78±4.80,t=-7.548,P<0.001)。多因素非条件logistic回归分析发现,中国肝癌分期Ⅲa~Ⅲb患者相对于Ⅰ~Ⅱa期患者预后不良发生概率更高[OR(95%CI)=5.332(1.058,26.875),P=0.043],随年龄和HSP90α水平增高及PNI值降低,TACE治疗后预后不良发生概率增高[年龄:OR(95%CI)=1.100(1.025,1.180),P=0.008;HSP90α水平:OR(95%CI)=1.049(1.029,1.070),P<0.001;PNI:OR(95%CI)=0.772(0.686,0.869),P<0.001]。血清HSP90α水平联合PNI区分HCC患者TACE治疗后预后不良的受试者操作特征曲线下面积为0.878[95%CI(0.820,0.922)]。结论从本�Objective To explore the predictive value of preoperative serum heat shock protein 90α(HSP90α)level in combination with the prognostic nutritional index(PNI)for patients with hepatocellular carcinoma(HCC)after transarterial chemoembolization(TACE).Methods The HCC patients confirmed by histopathological examination and underwent TACE at Guigang People’s Hospital from January 2022 to June 2023 were as the observation group,the healthy individuals who underwent physical examinations during the same period and same hospital as the control group.The blood before treatment and on the day of the physical examination was collected to detected the HSP90α and albumin levels,as well as lymphocyte count.The PNI was calculated[PNI=albumin(g/L)+5×lymphocyte count(×10^(9)/L)].The clinical outcome(tumor progression or death)was observed within one year after TACE treatment,those without tumor progression or death were defined as a good prognosis,while those with tumor progression or death were defined as a poor prognosis.Using the multivariate unconditional logistic regression analysis to identify the risk factors affecting the poor prognosis for HCC patients,and the receive operating characteristic(ROC)curve to evaluate the predictive value of serum HSP90α level in combination with PNI in distinguishing prognosis after TACE treatment.Results In this study,there were 178 cases in the observation group and 100 cases in the control group.The serum HSP90α level(μg/L)in the observation group was higher than that in the control group(96.40±33.57 vs.52.19±22.13,t=3.191,P<0.001),and the PNI value was lower than that in the control group(43.70±5.24 vs.56.46±6.86,t=-16.144,P<0.001);Within one year after TACE treatment,there were 70 patients with poor prognosis and 108 patients with good prognosis.The serum HSP90α(μg/L)level in the patients with poor prognosis was higher than that in the patients with good prognosis(117.33±29.48 vs.82.83±28.84,t=7.726,P<0.001),and the PNI was lower than that in the control group(40.49±4

关 键 词：肝细胞癌 经动脉化疗栓塞 热休克蛋白90Α 预后营养指数 预后 预测价值 

分 类 号：R73[医药卫生—肿瘤]