阴虚型HBV相关原发性肝癌患者的肿瘤特征及淋巴细胞计数与生化指标的相关性分析

发布时间：2018-06-19 20:25

  本文选题：肝肿瘤 + 肝炎病毒　； 参考：《临床肝胆病杂志》2016年03期

【摘要】：目的探讨阴虚型HBV相关原发性肝癌(PLC)患者的肿瘤特征及淋巴细胞计数与生化指标的相关性。方法收集2013年7月-2015年2月于首都医科大学附属北京地坛医院治疗的PLC患者148例,分为阴虚型PLC组(n=52)和非阴虚型PLC组(n=96)。收集患者的一般资料及实验室指标,包括肿瘤学指标[甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原(CA)19-9],病毒学指标(HBs Ag),肿瘤大体分型(结节型、块状型、巨块型、弥漫型),影像学特征(门静脉主干内径、门静脉癌栓、肝外转移),生化指标[终末期肝病模型(MELD)评分、白细胞(WBC)、红细胞(RBC)、血小板(PLT)、ALT、AST、TBil、GGT、ALP、白蛋白(Alb)、胆碱酯酶(CHE)、凝血酶原时间(PT)、凝血酶原活动度(PTA)]和淋巴细胞计数。符合正态分布的计量资料组间比较采用t检验,相关性分析采用Pearson相关分析;不符合正态分布的计量资料组间比较采用Mann-Whitney U检验,相关性分析采用Spearman相关分析。计数资料组间比较采用χ2检验。结果 2组患者的HBs Ag比较差异有统计学意义(χ2=5.658,P=0.017)。与非阴虚型PLC组相比,阴虚型PLC患者的CEA和CA19-9水平升高,2组间比较差异有统计学意义(U值分别为-2.200、-2.194,P值均0.05),MELD评分、TBil、PT升高(t=2.2、U=-2.0、U=-2.0,P值均0.05),PLT和PTA降低(U=-3.1、t=-2.5,P值均0.05),淋巴细胞、T淋巴细胞、CD8+T淋巴细胞、CD4+T淋巴细胞计数均降低(t=-2.7、U=-2.6、t=-2.2、U=-2.9,P值均0.05)。阴虚型PLC患者的CD4+T淋巴细胞计数与PLT、PTA呈正相关(r值分别为0.360、0.295,P值均0.05);CD8+T淋巴细胞计数与PLT、PTA呈正相关(r值分别为0.352、0.464,P值均0.05),与MELD评分、TBil、PT呈负相关(r值分别为-0.358、-0.378、-0.520,P值均0.05)。结论阴虚型PLC患者较其他证型肝癌患者肝脏合成功能更差、胆汁淤积更明显、免疫功能更为低下,且患者的CD4+T淋巴细胞计数越低,凝血功能越差;CD8+T淋巴细胞计数越低,凝血功能和肝脏储备功能均差。
[Abstract]:Objective to investigate the relationship between tumor characteristics, lymphocyte count and biochemical indexes in patients with HBV associated primary hepatocellular carcinoma (PLC-) with yin deficiency. Methods from July 2013 to February 2015, 148 PLCpatients treated in Beijing The Temple of Earth Hospital affiliated to Capital Medical University were divided into two groups: Yin-deficiency The Temple of Earth group (n = 52) and non-yin deficiency The Temple of Earth group (n = 96). The general data and laboratory data of patients were collected, including oncology, carcinoembryonic antigen (CEA), carbohydrate antigen (CAG) 19-9, virological index (HBs), gross tumor classification (nodular type, massive type, giant type). Diffuse type, imaging features (portal vein trunk diameter, portal vein tumor thrombus, extrahepatic metastasis, biochemical index [end stage liver disease model / MELDs] score; WBC, RBC, ALT, ALB, AlbN, cholinesterase, PTT, prothrombin activity (PTAs) and lymphocyte count. T test, Pearson correlation analysis and Mann-Whitney U test and Spearman correlation analysis were used in the comparison of measurement data with normal distribution and Pearson correlation analysis and without normal distribution respectively and with Mann-Whitney U test and Spearman correlation analysis respectively. 蠂 2 test was used to compare the counting data between groups. Results there was a significant difference in HBs Ag between the two groups (蠂 2 = 5.658%, P < 0.017). Compared with non-yin deficiency type PLC group, There were significant differences in CEA and CA19-9 levels between the two groups in Yin-deficiency type PLC patients with elevated levels of CEA and CA19-9. There were significant differences between the two groups. The P values were -2.200 and 2.194, respectively. The scores of TBilPT were 0.05PLT and 0.05PLT in T lymphocytes and CD4 T T cells in CD8 T lymphocytes in patients with Yin-deficiency type PLC. Both were 0.05PLT values and 0.05PLT values were lower than those in patients with PTA-3.1T cells. The lymphocyte counts were all decreased, the values of U ~ (2. 2) ~ (2. 2) ~ (2. 2) U ~ (2. 9) U ~ (2. 9) P were 0. 05 ~ 0. 5%. There was a positive correlation between CD4 T lymphocyte count and PLT PTA in patients with Yin-deficiency type. The positive correlation between CD 4 T lymphocyte count and PLT T lymphocyte count in PLC patients with Yin-deficiency type was 0.360 0. 295 and 0. 05% respectively. The positive correlation between CD4 T lymphocyte count and PLTT PTA was 0. 05% and 0. 05% respectively. The negative correlation between CD 4 T lymphocyte count and meld score was-0. 358U-0. 378- 0. 520g P, and 0. 05% P, respectively. The positive correlation between CD 4 T lymphocyte count and PLT T cell count was 0. 05%, P = 0. 05%, P = 0. 05%, P = 0. 05%. Conclusion the liver synthesis function, cholestasis and immune function of PLC patients with Yin-deficiency type are worse than those with other types of liver cancer, and the lower the CD4 T lymphocyte count, the lower the coagulation function and CD8 T lymphocyte count. The mean of coagulation function and hepatic reserve function were different.
【作者单位】： 首都医科大学附属北京地坛医院;首都医科大学重大传染病防治协同创新中心;
【基金】：北京市自然科学基金(7142081) 首都中医药研究专项课题(14ZY05) 北京卫生系统高层次人才培养项目(2013-3-026)
【分类号】：R512.62;R735.7
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