肝癌微波消融术前经肝动脉灌注介入治疗的临床效果及对肝癌患者FHIT、P16蛋白表达的影响
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摘要
[目的]探究肝癌微波消融术前行肝动脉灌注化疗栓塞(transhepatic arterial chemoembolization,TACE)介入治疗原发性肝癌(primary liver cancer,PLC)的临床效果及对患者脆性组氨酸三联体(fragile histidine triad,FHIT)和P16蛋白表达的影响。[方法]选取2016年3月～2018年3月我院收治的81例PCL患者,分成对照组(n=39)和观察组(n=42),对照组术前未进行化疗,观察组术前行TACE化疗,对2组患者临床疗效、肝功能及坏死面积、肿瘤直径、平均住院时间、病理分期、FHIT、P16蛋白表达、生活质量评分、近期生存率、复发率和不良反应发生情况进行比较。[结果]观察组的治疗总有效率为94.0%,显著高于对照的80.0%(P<0.05)。2组患者总胆红素(TBIL)、天门冬氨酸氨基转移酶(AST)、丙氨酸转氨酶(ALT)均显著降低,而白蛋白(ALB)显著上升,且观察组更优于对照组(P<0.05)。术后,2组患者FHIT及P16蛋白表达均上升,且观察组更高于对照组(P<0.05)。术后半年,观察组患者生活质量评分、生存率显著高于对照组,复发率显著低于对照组(P<0.05)。[结论]肝癌消融术前行肝动脉灌注介入治疗可为手术切除肿瘤病灶创造更好地条件,治疗后FHIT、P16蛋白表达升高对抑制肝癌细胞生长、提升患者近期生存率、降低不良反应发生率具有重要意义。
[Objective]To investigate the clinical effect of transhepatic arterial chemoembolization(TACE)in the treatment of primary liver cancer(PLC)before the microwave ablation of liver cancer and its effect on the fragile histidine triad(fragile histidine triad,FHIT)and P16 protein expression in patients with liver cancer.[Methods]81patients with PCL admitted to our hospital from March 2016 to March 2018 were enrolled in this study.They were divided into control group(n=39)and observation group(n=42).The control group did not receive chemotherapy before surgery,and the observation group underwent TACE chemotherapy before surgery.The clinical efficacy,liver function and necrotic area,tumor diameter,mean hospital stay,pathological stage,FHIT,P16 protein expression,quality of life score,short-term survival rate,recurrence rate and adverse reaction were compared between the two groups.[Results]The total effective rate of the observation group was 94.0%,which was significantly higher than that of the control(80.0%)(P<0.05).The total bilirubin(TBIL),aspartate aminotransferase(AST),and alanine aminotransferase(ALT)were significantly decreased in both groups,while albumin(ALB)was significantly increased in both groups,and the observation group was superior to the control group(P <0.05).After operation,the expression of FHIT and P16 protein in both groups increased,and the observation group was higher than the control group(P<0.05).The quality of life score and survival rate of patients in the observation group were significantly higher than those in the control group six months after operation,and the recurrence rate in the observation group was significantly lower than that in the control group(P<0.05).[Conclusion]Interventional hepatic artery perfusion before hepatic ablation can create better conditions for surgical resection of tumor lesions.Increased expression of FHIT and P16 protein after treatment is important for inhibiting the growth of hepatoma cells,improving the survival rate of patients and reducing the incidence of adverse reactions.significance.
[Objective]To investigate the clinical effect of transhepatic arterial chemoembolization(TACE)in the treatment of primary liver cancer(PLC)before the microwave ablation of liver cancer and its effect on the fragile histidine triad(fragile histidine triad,FHIT)and P16 protein expression in patients with liver cancer.[Methods]81patients with PCL admitted to our hospital from March 2016 to March 2018 were enrolled in this study.They were divided into control group(n=39)and observation group(n=42).The control group did not receive chemotherapy before surgery,and the observation group underwent TACE chemotherapy before surgery.The clinical efficacy,liver function and necrotic area,tumor diameter,mean hospital stay,pathological stage,FHIT,P16 protein expression,quality of life score,short-term survival rate,recurrence rate and adverse reaction were compared between the two groups.[Results]The total effective rate of the observation group was 94.0%,which was significantly higher than that of the control(80.0%)(P<0.05).The total bilirubin(TBIL),aspartate aminotransferase(AST),and alanine aminotransferase(ALT)were significantly decreased in both groups,while albumin(ALB)was significantly increased in both groups,and the observation group was superior to the control group(P <0.05).After operation,the expression of FHIT and P16 protein in both groups increased,and the observation group was higher than the control group(P<0.05).The quality of life score and survival rate of patients in the observation group were significantly higher than those in the control group six months after operation,and the recurrence rate in the observation group was significantly lower than that in the control group(P<0.05).[Conclusion]Interventional hepatic artery perfusion before hepatic ablation can create better conditions for surgical resection of tumor lesions.Increased expression of FHIT and P16 protein after treatment is important for inhibiting the growth of hepatoma cells,improving the survival rate of patients and reducing the incidence of adverse reactions.significance.
引文
[1]张金坤,王燕燕.原发性肝癌发生机制及其治疗的研究进展[J].中国药房,2015,26(29):4171-4173.
[2] Fohlen A,Tasu J P,Kobeiter H,et al.Transarterial chemoembolization(TACE)in the management of hepatocellular carcinoma:Results of a French national survey on current practices[J].Diagn Interv Imaging,2018,99(9):527-535.
[3]乔彬彬,虞希祥,王舒婷,等.TACE术中灌注氟尿嘧啶、奥沙利铂及吡柔比星治疗原发性肝癌的临床效果分析[J].介入放射学杂志,2015,24(4):349-353.
[4]黄伍奎,由丽娜,刘登尧,等.原发性肝癌肝动脉化疗栓塞术后肝损伤与乙肝相关性风险探讨[J].中国现代医学杂志,2015,25(20):78-82.
[5] Osório F M F,Resende V,Couto C A,et al.BRAF and FHIT expression in hcv related cirrhosis and hepatocellular carcinoma and their association with prognostic anatomopathological features[J].HPB,2016,18(1):e199.
[6]高涵,周涛,张春晶,等.细胞周期调控因子P16INK4、P57kip2和Ki67在肝癌中的表达及意义[J].重庆医学,2015,44(9):1165-1167.
[7]原发性肝癌诊疗规范(2017年版)[J].中国实用外科杂志,2017,37(7):705-720.
[8]张腾飞,黄修燕.外泌体生物学特性及其在肝癌中的作用研究[J].世界肿瘤研究,2018,8(1):12-17.
[9]江海中,邓新,钟永富.肝癌合并门静脉癌栓的TACE治疗[J].中国普通外科杂志,2015,24(1):116-120.
[10]Yao Q,Zhang H,Xiong B,et al.Combination of sorafenib and TACE inhibits portal vein invasion for intermediate stage HCC:a single center retrospective controlled study[J].Oncotarget,2017,8(45):79012-79022.
[11]朱川,熊德明,李湘宜,等.简化调强放疗联合肝动脉化疗栓塞治疗原发性肝癌的临床研究[J].重庆医学,2015,44(12):1626-1628.
[12]武中林,李智岗,吴晓云,等.经导管肝动脉栓塞与肝动脉灌注化疗栓塞在原发性肝癌介入治疗中的远期疗效比较[J].中国全科医学,2016,19(11):1292-1296.
[13]王立静,苗同国,宁更献,等.肝动脉化疗栓塞术对原发性肝癌患者T淋巴细胞亚群的影响[J].介入放射学杂志,2015,24(2):165-168.
[14]刘莹,王圆圆,贾文青,等.肺癌患者血清p16、FHIT、APC基因甲基化检测[J].郑州大学学报(医学版),2017,52(1):51-54.
[15]徐又先,袁林,濮德敏,等.宫颈癌中抑癌基因FHIT表达与HPV16基因状态[J].现代妇产科进展,2016,25(3):182-186.
[16]张成,柯阳,吴雪松,等.脆性组氨酸三联体基因转录外显子丢失与肝细胞癌易感性的Meta分析[J].肿瘤防治研究,2015,42(11):1124-1127.
[17]Guo Y,Wang J,Li H,et al.Mediator subunit 23overexpression as a novel target for suppressing proliferation and tumorigenesis in hepatocellular carcinoma[J].J Gastroenterol Hepatol,2015,30(6):1094-1103.
[18]黄密密,杨春,欧超,等.大鼠肝癌组织中DLC1、ASC、p16和DLK1基因甲基化状态与肝癌的关系[J].中国癌症防治杂志,2015,7(2):80-84.
[2] Fohlen A,Tasu J P,Kobeiter H,et al.Transarterial chemoembolization(TACE)in the management of hepatocellular carcinoma:Results of a French national survey on current practices[J].Diagn Interv Imaging,2018,99(9):527-535.
[3]乔彬彬,虞希祥,王舒婷,等.TACE术中灌注氟尿嘧啶、奥沙利铂及吡柔比星治疗原发性肝癌的临床效果分析[J].介入放射学杂志,2015,24(4):349-353.
[4]黄伍奎,由丽娜,刘登尧,等.原发性肝癌肝动脉化疗栓塞术后肝损伤与乙肝相关性风险探讨[J].中国现代医学杂志,2015,25(20):78-82.
[5] Osório F M F,Resende V,Couto C A,et al.BRAF and FHIT expression in hcv related cirrhosis and hepatocellular carcinoma and their association with prognostic anatomopathological features[J].HPB,2016,18(1):e199.
[6]高涵,周涛,张春晶,等.细胞周期调控因子P16INK4、P57kip2和Ki67在肝癌中的表达及意义[J].重庆医学,2015,44(9):1165-1167.
[7]原发性肝癌诊疗规范(2017年版)[J].中国实用外科杂志,2017,37(7):705-720.
[8]张腾飞,黄修燕.外泌体生物学特性及其在肝癌中的作用研究[J].世界肿瘤研究,2018,8(1):12-17.
[9]江海中,邓新,钟永富.肝癌合并门静脉癌栓的TACE治疗[J].中国普通外科杂志,2015,24(1):116-120.
[10]Yao Q,Zhang H,Xiong B,et al.Combination of sorafenib and TACE inhibits portal vein invasion for intermediate stage HCC:a single center retrospective controlled study[J].Oncotarget,2017,8(45):79012-79022.
[11]朱川,熊德明,李湘宜,等.简化调强放疗联合肝动脉化疗栓塞治疗原发性肝癌的临床研究[J].重庆医学,2015,44(12):1626-1628.
[12]武中林,李智岗,吴晓云,等.经导管肝动脉栓塞与肝动脉灌注化疗栓塞在原发性肝癌介入治疗中的远期疗效比较[J].中国全科医学,2016,19(11):1292-1296.
[13]王立静,苗同国,宁更献,等.肝动脉化疗栓塞术对原发性肝癌患者T淋巴细胞亚群的影响[J].介入放射学杂志,2015,24(2):165-168.
[14]刘莹,王圆圆,贾文青,等.肺癌患者血清p16、FHIT、APC基因甲基化检测[J].郑州大学学报(医学版),2017,52(1):51-54.
[15]徐又先,袁林,濮德敏,等.宫颈癌中抑癌基因FHIT表达与HPV16基因状态[J].现代妇产科进展,2016,25(3):182-186.
[16]张成,柯阳,吴雪松,等.脆性组氨酸三联体基因转录外显子丢失与肝细胞癌易感性的Meta分析[J].肿瘤防治研究,2015,42(11):1124-1127.
[17]Guo Y,Wang J,Li H,et al.Mediator subunit 23overexpression as a novel target for suppressing proliferation and tumorigenesis in hepatocellular carcinoma[J].J Gastroenterol Hepatol,2015,30(6):1094-1103.
[18]黄密密,杨春,欧超,等.大鼠肝癌组织中DLC1、ASC、p16和DLK1基因甲基化状态与肝癌的关系[J].中国癌症防治杂志,2015,7(2):80-84.