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血清ALP、GGT水平对射频消融术治疗原发性肝癌患者预后的影响
Influence of serum levels of alkaline phosphatase and gamma-glutamyl transpeptidase on the prognosis of patients with primary liver cancer undergoing radiofrequency ablation
文章发布日期:2016年11月04日  来源:  作者:朱歌,赵玲玲,钱磊,等  点击次数:1032次  下载次数:269次

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【摘要】:目的探讨治疗前血清ALP、GGT水平对射频消融术治疗原发性肝癌患者预后的影响。方法收集2010年10月-2015年6月吉林大学第一医院肿瘤中心收治的165例经病理或临床确诊为原发性肝癌并接受射频消融治疗的患者术前的临床资料。计数资料组间比较采用χ2检验,采用Kaplan-Meier法及Cox回归分析治疗前血清ALP、GGT水平与患者总生存期、无进展生存期及临床特点的关系。结果治疗前血清ALP正常(≤135 U/L)及异常(>135 U/L)患者的1年生存率分别为91%和79%,2年生存率分别为90%和68%,5年生存率分别为35%和18%,两组差异有统计学意义(P=0.01);治疗前血清GGT正常(≤45 U/L)及异常(>45 U/L)患者的1年生存率分别为95%和87%,2年生存率分别为85%和71%,5年生存率分别为37%和21%,两组差异有统计学意义(P<0.001)。治疗前血清ALP[风险比(HR)=1.766,95%可信区间(95%CI):1.068~2.921),P=0027]及GGT(HR=2.312,95%CI:1.367~3912,P=0002)与原发性肝癌患者射频消融术后的总生存期密切相关,是其独立预后影响因素。治疗前血清ALP正常及异常患者的1年无进展生存率分别为72%和50%,2年无进展生存率分别为52%和21%,5年无进展生存率分别为14%和3%,两组差异有统计学意义(P<0.001);治疗前血清GGT正常及异常患者的1年无进展生存率分别为81%和56%,2年无进展生存率分别为62%和35%,5年无进展生存率分别为18%和7%,两组差异有统计学意义(P<0.001)。治疗前血清ALP(HR=1.653,95%CI: 1.001~2.729,P=0049)及GGT水平(HR=1.949,95%CI:1.296~2.930,P=0001)与原发性肝癌患者射频消融术后的无进展生存期密切相关。在ALP异常患者中,男性患者比例高,肝功能Child-Pugh分级差,腹水发生率高;GGT异常患者中,肝功能Child-Pugh分级差,肿瘤分期晚,肿瘤≥5 cm患者比例高,肝性脑病发生率高。结论治疗前血清ALP、GGT水平可用于预测原发性肝癌患者射频消融术后的预后,二者对原发性肝癌患者射频治疗后的远期生存具有一定的指导意义。
【Abstract】:ObjectiveTo investigate the influence of serum levels of alkaline phosphatase (ALP) and gamma-glutamyltransferase (GGT) before treatment on the prognosis of patients with primary liver cancer undergoing radiofrequency ablation. MethodsA total of 165 patients with pathologically or clinically confirmed primary liver cancer who were admitted to Cancer Center of The First Hospital of Jilin University from October 2010 to June 2015 and treated with radiofrequency ablation were enrolled, and their preoperative clinical data were collected. The chi-square test was used for comparison of categorical data between groups, and the Kaplan-Meier method and Cox regression analysis were used to analyze the association of serum ALP and GGT levels before treatment with overall survival, progression-free survival, and clinical features. ResultsThere were significant differences in the 1-, 2-, and 5-year survival rates between the patients with normal (≤135 U/L) or abnormal (>135 U/L) serum ALP before treatment (91%/90%/35% vs 79%/68%/18%, P=0.01). There were also significant differences in the 1-, 2-, and 5-year survival rates between the patients with normal (≤45 U/L) or abnormal (>45 U/L) serum GGT before treatment (95%/85%/37% vs 87%/71%/21%, P<0.001). The serum levels of ALP (HR=1.766, 95%CI:1.068-2.921,P=0027) and GGT (HR=2.312, 95%CI:1.367-3.912,P=0002) before treatment were closely associated with the overall survival of patients with primary liver cancer after radiofrequency ablation and were independent prognostic factors. There were significant differences in the 1-, 2-, and 5-year progression-free survival rates between the patients with normal (≤135 U/L) or abnormal (>135 U/L) serum ALP before treatment (72%/52%/14% vs 50%/21%/3%, P<0.001); there were also significant differences in the 1-, 2-, and 5-year progression-free survival rates between the patients with normal (≤45 U/L) or abnormal (>45 U/L) serum GGT before treatment (81%/62%/18% vs 56%/35%/7%, P<0.001). The serum levels of ALP (HR=1.653, 95%CI:1.001-2.729,P=0049) and GGT (HR = 1.949, 95%CI:1.296-2.930,P=0001) before treatment were closely associated with the progression-free survival of patients with primary liver cancer after radiofrequency ablation. There were more male patients with abnormal ALP than the female patients, and the patients with abnormal ALP had high incidence rates of poor Child-Pugh classification and ascites. In the patients with abnormal GGT (>45 U/L), there was a high proportion of patients with poor Child-Pugh classification, late tumor stages, and a tumor size of ≥5 cm and a high incidence rate of hepatic encephalopathy. ConclusionThe serum levels of ALP and GGT before treatment can be used to predict the prognosis of patients with primary liver cancer after radiofrequency ablation and have certain guiding significance for the long-term survival of patients with primary liver cancer after radiofrequency ablation.
【关键字】:肝肿瘤; 碱性磷酸酶; γ-谷氨酰转肽酶; 导管消融术; 预后
【Key words】:liver neoplasms; alkaline phosphatase; gamma-glutamyltransferase; catheter ablation; prognosis
【引证本文】:朱歌, 赵玲玲, 钱磊, 等. 血清ALP、GGT水平对射频消融术治疗原发性肝癌患者预后的影响[J]. 临床肝胆病杂志, 2016, 32(12):2342-2346.

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