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外周血清5-羟色胺与血小板水平对肝细胞癌患者预后的影响
fanhaining@medmail.com.cn。Influence of 5-hydroxytryptamine and platelet count in peripheral blood on the prognosis of patients with hepatocellular carcinoma
文章发布日期:2020年06月08日  来源:  作者:王志鑫,李姚,周留馨,等  点击次数:306次  下载次数:28次

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【摘要】:目的 探究血小板及其内源性5-羟色胺(5-HT)与肝细胞癌患者预后的关系。方法 回顾性分析西安交通大学第一附属医院2004年1月-2012年12月治疗的210例肝细胞癌患者资料,并根据血小板计数高低分为低血小板组(n=129)与高血小板组(n=81),对比组间差异因素并进行预后分析。收集20例住院复发/转移肝癌患者及32例非复发/转移肝癌患者外周血标本,用ELISA法检测患者外周血清5-HT水平,血小板聚集仪检测血小板聚集率。血小板计数与肝癌临床病理因素之间的关系分析采用χ2检验;不同肝癌分组患者的外周血小板计数、聚集率及外周血5-HT水平比较采用Mann-Whitney U检验。血小板计数与生存期相关性以及5-HT水平与血小板计数、聚集率相关性分析采用一元线性回归。生存率及复发率分析采用Kaplan-Meier法,组间比较采用log-rank检验,影响肝癌患者预后因素分析使用Cox回归分析。结果 不同血小板水平患者的年龄(χ2=32.304,P=0.044)、肿瘤大小(χ2=35.201,P=0.001)、肿瘤数目(χ2=31.304,P=0.032)、Child分级(χ2=31.250,P=0.036)及TNM分期(χ2=35.201,P=0.001)等指标差异均有统计学意义。多因素Cox分析显示,与患者整体生存相关的独立危险因素有年龄、入院AFP水平、入院血小板计数、治疗方式(P值均<0.05),而与无复发生存相关的危险因素包括年龄、入院AFP水平、肿瘤大小、入院血小板计数、治疗方式(P值均<0.05)。生存分析发现,高血小板组相对低血小板组具有更低的整体生存率和更高的复发率(χ2值分别为34.060和31.030,P值均<0.001)。随着血小板计数的增加,患者整体和无复发生存期均呈现下降趋势(R2OS=0.034, POS=0.007; R2DFS=0. 045, PDFS=0.002)。肝癌复发/转移组血小板计数、血小板聚集率、血清游离5-HT水平显著高于非复发/转移组,差异均有统计学意义(U值分别为2.950、2.363、3.082,P值分别为0.041、0.043、0.048)。进一步相关性分析发现,血清5-HT水平与外周血小板计数及最大聚集率均呈正相关(P值均<0.05)。结论 血小板计数是肝细胞癌患者整体生存及复发/转移的独立危险因素;外周血5-HT水平与血小板计数、血小板聚集率正相关,可能是预测患者预后的潜在指标。
【Abstract】:Objective To investigate the association of platelet and its endogenous 5-hydroxytryptamine (5-HT) with the prognosis of patients with hepatocellular carcinoma (HCC). Methods A retrospective analysis was performed for the clinical data of 210 patients with HCC who were treated in The First Affiliated Hospital of Xi’an Jiaotong University from January 2004 to December 2012, and according to platelet count, the patients were divided into low platelet group and high platelet group. Related factors and prognosis were compared between two groups. Peripheral blood samples were collected from 20 patients with recurrent/metastatic liver cancer and 32 patients with non-recurrent/metastatic liver cancer; ELISA was used to measure the serum level of 5-HT, and the platelet aggregation instrument was used to measure platelet aggregation rate. The chi-square test was used to investigate the association between platelet count and the clinicopathological characteristics of liver cancer, and the Mann-Whitney U test was used to compare platelet count, platelet aggregation rate, and 5-HT level in peripheral blood between groups. A univariate linear regression analysis was used to investigate the association between platelet count and survival time, as well as the association of 5-HT level with platelet count and platelet aggregation rate. The Kaplan-Meier method was used to analyze survival rate and recurrence rate, the log-rank test was used for comparison between groups, and a Cox regression analysis was used to investigate the influencing factors for the prognosis of HCC patients. Results There were significant differences between the patients with different platelet counts in age (χ2=32.304, P=0.044), tumor size (χ2=35.201, P=0.001), number of tumors (χ2=31.304, P=0.032), Child class (χ2=31.250, P=0.036), and TNM stage (χ2=35.201, P=0.001). The multivariate Cox regression analysis showed that age, alpha-fetoprotein (AFP) level on admission, platelet count on admission, and treatment modality were independent risk factors associated with overall survival (all P<0.05), while age, AFP level on admission, tumor size, platelet count on admission, and treatment modality were risk factors associated with recurrence-free survival (all P<0.05). The survival analysis showed that compared with the low platelet group, the high platelet group had a significantly lower overall survival rate (χ2=34.060, P<0.001) and a significantly higher recurrence rate (χ2=31.030, P<0.001). With the increase in platelet count, overall survival and recurrence-free survival tended to decrease (R2OS= 0.034, POS=0.007; R2DFS=0.045, PDFS=0.002). Compared with the non-recurrent/metastatic liver cancer group, the recurrent/metastatic liver cancer group had significantly higher platelet count (U=2.950, P=0.041), platelet aggregation rate (U=2.363, P=0.043), and serum free 5-HT level (U=3.082, P=0.048). The correlation analysis showed that serum 5-HT level was positively correlated with platelet count and maximum platelet aggregation rate in peripheral blood (both P<0.05). Conclusion Platelet count is an independent risk factor for overall survival and recurrence/metastasis in patients with HCC. Peripheral 5-HT level is positively correlated with platelet count and platelet aggregation rate and may be one of the potential indices for predicting the prognosis of HCC patients.
【关键字】:癌,肝细胞; 血小板; 血清素; 预后
【Key words】:carcinoma,hepatocellular; blood platelets; serotonin; prognosis
【引证本文】:WANG ZX, LI Y, ZHOU LX, et al. Influence of 5-hydroxytryptamine and platelet count in peripheral blood on the prognosis of patients with hepatocellular carcinoma[J]. J Clin Hepatol, 2020, 36(7): 1534-1539. (in Chinese)
王志鑫, 李姚, 周留馨, 等. 外周血清5-羟色胺与血小板水平对肝细胞癌患者预后的影响[J]. 临床肝胆病杂志, 2020, 36(7): 1534-1539.

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