DCP联合影像学评估TACE治疗原发性肝癌的应用价值

发布时间：2018-03-05 17:01

本文选题：原发性肝癌　切入点：脱-γ-羧基凝血酶原　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨血清AFP、DCP及Child-Pugh分级在评估HBV(hepatitis B virus,HBV)相关HCC(hepatocellular carcinoma,HCC)患者TACE(transcatheter arterial chemoembolization,TACE)治疗效果的应用价值;分析血清DCP、AFP表达水平变化与影像学评价相关性,探讨血清DCP、AFP表达水平变化联合影像学检查评估HCC治疗效果的应用价值。方法:收集北京军区总医院全军肝病治疗中心66例HBV相关HCC且首次治疗采用TACE治疗方式的患者血液标本及相关临床资料,并对其进行规律随访。分别采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测血清DCP浓度,电化学发光免疫法检测血清AFP浓度,对DCP及AFP均阳性的患者进行规律随访,检测其治疗前后浓度的变化。定义治疗后1月血清DCP、AFP浓度较入院时下降≥20%评0分,下降20%或较前升高评1分,术前Child-Pugh A级评0分,B级评1分,分析综合评分≤1分和≥2分患者治疗效果。在随访的第1、3、6个月时检测血清DCP、AFP浓度,定义其DCP、AFP较入院时下降≥50%为血清学缓解,分析并比较肿瘤标志物血清学缓解与影像学m-RECIST评价的相关性和疾病进展时间的关系。结果:(1)66例HCC患者中有57(86.4%)例血清DCP阳性。对DCP和AFP的表达水平进行相关性分析,结果显示血清DCP水平与AFP水平不存在相关性(r=-0.194,P=0.145)。血清DCP浓度与HCC患者BCLC分期、肿瘤直径、肿瘤数目及门脉癌栓有关,与性别、年龄、病毒载量、肝功能Child-PughA/B无关。(2)57例患者中综合评分≤1分的有40例,综合评分≥2分的有17例。综合评分≤1分的患者较评分≥2分患者明显具有更高的影像学缓解率(77.5%vs41.2%),差异具有统计学意义(c2=7.083,P=0.008)。生存分析显示综合评分≤1分患者和综合评分≥2分患者中位疾病进展时间(TTP)分别为10±0.79个月和6±0.66个月,两者疾病进展时间差异有统计学意义(c2=22.437,P0.001)。(3)57例患者随访第1、3、6个月。AFP血清学缓解率分别为66.7%、77.2%、71.9%。随访期间血清学评价(缓解/未缓解)与影像学评价(CR+PR)与(SD+PD)例数无统计学差异。DCP血清学缓解率分别为52.6%、63.2%、54.4%。随访第1、3个月时血清学评价(缓解/未缓解)与影像学评价(CR+PR)与(SD+PD)例数无统计学差异,在第6个月时两者出现统计学差异(c2=7.743 P=0.031)。(4)对57例患者进行生存分析显示,TACE治疗后,获得血清缓解的患者明显具有更长的疾病进展时间。AFP组血清学缓解/未缓解的TTP为10±1.21个月vs7±1.11个月(c2=5.673,P=0.017)。DCP组血清学缓解/未缓解的TTP为10±0.89个月vs6±0.52个月(c2=14.949,P0.001)。结论:1.血清DCP在HCC患者中呈不同程度的高表达,其表达水平与AFP水平无相关性,与患者年龄、性别及HBV病毒载量不相关,与肿瘤直径、个数、门脉癌栓及BCLC分期关系密切。2.血清AFP、DCP变化及肝功能Child-Pugh A/B评分可以用于评估TACE治疗效果。3.血清AFP检测联合影像学检查,对肿瘤患者治疗效果及预后评价具有一定意义。4.血清DCP变化联合影像学检查评估肿瘤治疗效果只是初步探索,尚需进一步研究。
[Abstract]:Objective: To investigate the serum levels of AFP, DCP and Child-Pugh in the assessment of HBV (hepatitis B grade virus, HBV) HCC (hepatocellular carcinoma HCC) in patients with TACE (transcatheter arterial chemoembolization, TACE) application value of the treatment effect; analysis of serum DCP, AFP expression and imaging evaluation of correlation of serum DCP, the application value of AFP the expression levels of combined imaging evaluation of therapeutic effect of HCC examination. Methods: We collected 66 cases of liver disease treatment center of General Hospital of Beijing Military Region of PLA HBV HCC for the first time and treated by TACE in the treatment of patients with blood samples and clinical data, and regular follow-up on it. Were assayed by enzyme linked immunosorbent assay (enzyme-linked immunosorbent, assay, ELISA) detection the concentration of serum DCP, electrochemiluminescence immunoassay to detect serum AFP concentration of DCP and AFP patients were positive for regular follow-up, its detection The concentration changes before and after treatment. After treatment in January defined serum DCP, AFP concentration decreased when compared with those on admission of more than 20% Rated 0 points, down 20% or higher than before the preoperative Child-Pugh score of 1 points, a score of 0 points, B score of 1 points, analysis of comprehensive score of 1 or less and more than 2 patients. The treatment effect of detection serum DCP, 1,3,6 in the months when the concentration of AFP, the definition of DCP, AFP decreased when compared with those on admission of more than 50% for serological remission, analysis and comparison of serum tumor markers in m-RECIST remission time evaluation and image correlation and disease. Results: (1) in 66 patients with HCC (57 86.4%) serum DCP were positive. Correlation analysis was performed on the expression of DCP and AFP, the results showed that serum DCP level and AFP level has no correlation (r=-0.194, P=0.145). The concentration of serum DCP in patients with HCC BCLC stage, tumor diameter, tumor number and portal vein cancer embolus, and gender, age, viral load The amount of liver function, independent of Child-PughA/B. (2) 57 cases of patients with comprehensive score less than or equal to 1 points in 40 cases, the comprehensive score of equal or greater than 2 points in 17 cases. The comprehensive score less than 1 points score more than 2 points were significantly higher radiological remission rate (77.5%vs41.2%), the difference has statistical meaning the meaning of (c2=7.083, P=0.008). Survival analysis showed that the comprehensive score less than 1 points and the total score than patients with TTP 2 patients (TTP) were 10 + 0.79 and 6 + months 0.66 months, there was statistical significance between the differences in disease progression (c2=22.437, P0.001) (3) of 57 cases. The patients were followed up for 1,3,6 months.AFP serological remission rate was 66.7%, 77.2%, 71.9%. during follow-up serological evaluation (remission / remission) evaluation and imaging (CR+PR) and (SD+PD) the number of cases there was no significant difference in.DCP serological remission rates were 52.6%, 63.2%, 54.4%. in 1,3 months follow-up when serological evaluation (remission / Nonremitters) evaluation and imaging (CR+PR) and (SD+PD) the number of cases was no significant difference between the two in sixth months and there was significant difference (c2=7.743 P=0.031). (4) of 57 patients were survival analysis showed that after TACE treatment, serum obtained remission has obvious progress more long time.AFP disease group / non remission TTP serological remission was 10 + 1.21 months VS7 1.11 months (c2=5.673, P=0.017) /.DCP serum remission without remission TTP was 10 + 0.89 months VS6 0.52 months (c2=14.949, P0.001). Conclusion: 1. the serum DCP was highly expressed in different degree in HCC the patients, there was no correlation between the expression level of AFP, and age, sex and HBV viral load was not associated with tumor size, number, the relationship between portal vein tumor thrombus and BCLC staging closely.2. serum AFP, DCP and changes of liver function Child-Pugh A/B score can be used to evaluate the curative effect of TACE.3. on serum AFP Combined imaging examination has certain significance for the prognosis and prognosis of tumor patients..4. serum DCP changes combined with imaging examination to evaluate the effect of tumor treatment is only preliminary exploration, and further research is needed.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.7

【相似文献】