【作者】 朱军；

【导师】 刘一之；

【作者基本信息】 苏州大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的:研究肝癌患者TACE(transcatheter arterial chemoembolization)前后血清肝细胞生长因子(hepatocyte growth factor, HGF)水平的动态变化,分析影响肝癌患者TACE术前、术后血清HGF水平的因素,探讨其临床意义。材料与方法:以37例慢性乙型肝炎基础上的肝癌患者为研究对象,用酶联免疫吸附法(enzyme linked immunosorbent assay, ELISA)测定TACE术前1天,术后第3、7、28天血清HGF浓度,分析术前血清HGF水平与性别、年龄、肿瘤分期、肿瘤大小、术前肝功能Child-Pugh分级、术前血清甲胎蛋白水平以及有无门静脉癌栓等不同影响因素之间的关系,分析血清HGF水平与肿瘤转移的关系,分析栓塞范围与术后血清HGF水平变化的关系。并以15例健康献血者作为正常对照组,以15例慢性乙型肝炎患者及15例慢性乙型肝炎肝硬化患者作为慢性肝炎组和肝硬化组。结果:肝癌患者TACE术前血清HGF浓度为[(0.69±0.17)ng/ml],显著高于正常对照组[(0.24±0.05)ng/ml]、慢性肝炎组[(0.34±0.06)ng/ml]以及肝硬化组[(0.38±0.10)ng/ml] (P<0.01);慢性肝炎组与肝硬化组差异无统计学意义(P=0.26),但均高于正常对照组(P<0.01)。肝癌患者TACE术后血清HGF浓度上升高峰出现在术后第3天[(1.10±0.39)ng/ml],术后第7天逐渐下降[(0.76±0.20)ng/ml],术后第28天基本恢复术前水平[(0.71±0.18)ng/ml],术前1天及术后第3、7、28天各组的血清HGF组间比较,仅术后第3天组差异有统计学意义(P<0.01)。影响术前血清HGF水平的主要因素有:肿瘤分期、肿瘤大小以及门静脉癌栓。13例肝癌患者TACE术后发现肿瘤转移,其术前、术后血清HGF水平均显著高于未发现肿瘤转移的患者(P<0.01)。16例肝癌患者行大范围栓塞,其术后第3天血清HGF水平上升值显著高于小范围栓塞的患者[(0.55±0.26)ng/ml vs (0.30±0.22)ng/ml, P<0.01]。7例患者在随访期内死亡,其TACE术前血清HGF水平均>0.8ng/ml,而血清HGF水平<0.8ng/ml的患者未见死亡。结论:血清HGF水平可作为协助肝癌诊断和TACE术后预后判断的肿瘤标记物之一,肝癌患者TACE前后血清HGF水平的持续升高可能与肿瘤转移有关。更多还原

【Abstract】 OBJECTIVE: To analyze the changes in serum concentrations of hepatocyte growth factor after transcatheter arterial chemoembolization for hepatocellular carcinoma and its clinical significance.METHODS: Thirty seven patients with HCC undergoing TACE were studied. Serum HGF levels were determined using ELISA kit before and after TACE respectively. The correlations of clinical pathologic parameters with the serum HGF concentration were analyzed respectively. Serum HGF concentrations of 15 healthy blood donors and 15 patients with chronic viral hepatitis B and 15 patients with liver cirrhosis were studied as control respectively.RESULTS: The mean HGF level in the HCC group was significantly higher than in the normal controls and the CH group and the LC group [(0.69±0.17)ng/ml vs (0.24±0.05)ng/ml and (0.34±0.06)ng/ml and (0.38±0.10)ng/ml, P<0.01]. There was a peak of serum HGF concentrations on the third day after TACE [(1.10±0.39)ng/ml], and declined on the seventh day [(0.76±0.20)ng/ml], and then returned to normal level on the twenty-eighth day [(0.71±0.18)ng/ml]. Serum HGF concentrations were positively correlated with tumor stage, tumor size, portal vein tumor thrombus. The patients with metastases after TACE had a higher level of serum HGF than others. The patients who were treated with larger volumes had a higher level of serum HGF than those who were treated with smaller volumes on the third day after TACE [(0.55±0.26)ng/ml vs (0.30±0.22)ng/ml, P<0.01]. Seven patients died during 1-year follow-up whose serum HGF were higher than 0.8ng/ml, while no patients died whose serum HGF were lower than 0.8ng/ml. CONCLUSION: Serum HGF level is a useful tumor marker and an indicator of prognosis for patient with HCC, the sustained high level of HGF may be a factor related to early tumor metastases after TACE.更多还原