血清1,6-二磷酸果糖醛缩酶评价消融治疗原发性肝癌疗效的研究
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摘要
目的：探讨血清1，6-二磷酸果糖醛缩酶(Fructose-1，6-bisphate-Aldolase，FDP-ALD)测定对经皮肝穿无水酒精瘤内注射术(PEI)及经皮肝穿射频消融(RF)治疗原发性肝癌(HCC)疗效评价的价值。
方法：32例HCC患者分为两组，PEI组18例共24个肿瘤结节；射频组14例共14个肿瘤结节。检测PEI及RF治疗HCC后不同时点的血清FDP-ALD、谷丙转氨酶(ALT)、谷草转氨酶(AST)、甲胎蛋白(AFP)的变化并进行相应比较。结果：HCC病人血清FDP-ALD活性明显高于对照组(P＜0.05)。PEI组血清FDP-ALD活性在第一次PEI术后达最高值，随后呈波浪状下降，第八次回到术前水平，疗程结束后一个月低于术前水平；RF组术后第一天FDP-ALD达最高值，随后呈直线下降，第七天回到术前水平，疗程结束后一个月低于术前水平。血清AFP浓度治疗后均呈下降趋势，术前、术后比较差异有显著性(P＜0.05)。血清FDP-ALD与AFP于术前及术中的分布均不一致，但在疗程结束后一个月两者的分布趋向一致。提示血清FDP-ALD活性变化可反映肝癌组织的坏死程度，可作为评价HCC治疗疗效的血清学指标之一，特别可补充AFP阴性者不能通过血清AFP监测来
评价HCC治疗疗效的不足。血清ALT、AST及Fm－ALD的各次测
量值间有差即＜0．05）IEI组第一次到第四次PEI治疗后血清ALT、
AST升高，与术前比较差异有显著性爬＜0．05；第五次后肝酶水平接
近械水平。y组崛ALT、AST术后第17iM高，第3、5大逐渐
下降，但与术前比较差异均有显著性o＜0．仍入术后第7天回到术前
水平。结论：血清FDP－Aid活性在肝癌病人明显升高，可用于肝癌
的诊断；肝癌消融治疗后血清FDP－Aid活性测定可用于肝癌消融治
疗的疗效评价，对AF P阴性的肝癌患者治疗后也有判断疗效的价值：
血清 ALT和 AST的测定可反映出癌旁肝组织的损害髓，腑M
－Aid活性测定结合血清ALT和 AST的测定则可用于评判肝癌消融
治疗的彻底性。
Objection: The purpose of this study was to evaluate the value of fructose 1,6-diphosphate (FDP) aldolase in detected tumorous tissue damaged by Percutaneous Ethanol Injection(PEI) and Radio-frequency ( RF) Ablation in patients of Hepatocellular Carcinoma(HCC). Methods: 32 patients with HCC containing 38 tumor nodules were divided into two groups: PEI and RF groups. In PEI group, there werelS patients with 24 tumor nodules, and 14 patients with 14 tumor nodules were in RF group. Changes in serum levels of FDP aldolase activities were analyzed in patients with HCC treated by PEI and RF at different time. Activities of serum alanine aminotransferase(ALT) > aspartate aminotransferase(AST) and the levels of serum alpha-fetoprotein (AFP) were also measured. These indexes were compared between pre-treatment and post-treatment. In order to learn the distribution, we compared serum FDP aldolase with AFP -. AUI\ AST, respectively. Results: Serum levels of FDP aldolase in HCC were higher than the controls pre-treatment . Serum levels of FDP
aldolase released by ethanol injection were increased (P < 0.05) after the first PEI and thereafter decreased just like the wave. After the eighth PEI, it came back to the levels of pre-treatment. In group RF, serum levels of FDP aldolase were increased after twenty-four hours, and then descend straightly (P < 0.05); It came back in pre-treatment after seven days. Changes in serum levels of FDP Aldolase indicated tumor tissue necrosis in HCC. Serum levels of AFP were decreased after treatment ,and there were significant different between pre- and post-treatment, it also indicating adequate tumor tissue necrosis. The difference between activitise of serum FDP aldolase and ALT\ AST were significance(P < 0.05) at each treatment. In PEI group, Serum levels of ALT> AST were elevated after repeated PEI from first to fourth time. Compared with pre-treatment, it had significantly different (P < 0.05) . After the fifth PEI, Serum levels of ALT> AST were similar to pre-treatment. In RF group , Serum levels of AUI\ AST were highest in the first day after treatment, and then they were progressive decreased in the third and fifth day, but still had signifficanl different (P < 0.05) comparing with pre-treatment. After one week, serum levels of ALT> AST were similar to levels of pre-treatment. Conclusions: Serum levels of FDP aldolase have increased significantly in HCC, it is available to diagnosis of HCC. Measurement of FDP activities in serum
after ablation treatment is clinically useful to detect the degree of tumorous tissue damage ^specially for the case that AFP is negative. Serum levels of ALT- AST can be indicated lesion degree in tissue beside the tumor. Combining with ALT\ AST, Serun levels of FDP aldolase has great value in the judgement of necrosis in tumor tissue.
方法：32例HCC患者分为两组，PEI组18例共24个肿瘤结节；射频组14例共14个肿瘤结节。检测PEI及RF治疗HCC后不同时点的血清FDP-ALD、谷丙转氨酶(ALT)、谷草转氨酶(AST)、甲胎蛋白(AFP)的变化并进行相应比较。结果：HCC病人血清FDP-ALD活性明显高于对照组(P＜0.05)。PEI组血清FDP-ALD活性在第一次PEI术后达最高值，随后呈波浪状下降，第八次回到术前水平，疗程结束后一个月低于术前水平；RF组术后第一天FDP-ALD达最高值，随后呈直线下降，第七天回到术前水平，疗程结束后一个月低于术前水平。血清AFP浓度治疗后均呈下降趋势，术前、术后比较差异有显著性(P＜0.05)。血清FDP-ALD与AFP于术前及术中的分布均不一致，但在疗程结束后一个月两者的分布趋向一致。提示血清FDP-ALD活性变化可反映肝癌组织的坏死程度，可作为评价HCC治疗疗效的血清学指标之一，特别可补充AFP阴性者不能通过血清AFP监测来
评价HCC治疗疗效的不足。血清ALT、AST及Fm－ALD的各次测
量值间有差即＜0．05）IEI组第一次到第四次PEI治疗后血清ALT、
AST升高，与术前比较差异有显著性爬＜0．05；第五次后肝酶水平接
近械水平。y组崛ALT、AST术后第17iM高，第3、5大逐渐
下降，但与术前比较差异均有显著性o＜0．仍入术后第7天回到术前
水平。结论：血清FDP－Aid活性在肝癌病人明显升高，可用于肝癌
的诊断；肝癌消融治疗后血清FDP－Aid活性测定可用于肝癌消融治
疗的疗效评价，对AF P阴性的肝癌患者治疗后也有判断疗效的价值：
血清 ALT和 AST的测定可反映出癌旁肝组织的损害髓，腑M
－Aid活性测定结合血清ALT和 AST的测定则可用于评判肝癌消融
治疗的彻底性。
Objection: The purpose of this study was to evaluate the value of fructose 1,6-diphosphate (FDP) aldolase in detected tumorous tissue damaged by Percutaneous Ethanol Injection(PEI) and Radio-frequency ( RF) Ablation in patients of Hepatocellular Carcinoma(HCC). Methods: 32 patients with HCC containing 38 tumor nodules were divided into two groups: PEI and RF groups. In PEI group, there werelS patients with 24 tumor nodules, and 14 patients with 14 tumor nodules were in RF group. Changes in serum levels of FDP aldolase activities were analyzed in patients with HCC treated by PEI and RF at different time. Activities of serum alanine aminotransferase(ALT) > aspartate aminotransferase(AST) and the levels of serum alpha-fetoprotein (AFP) were also measured. These indexes were compared between pre-treatment and post-treatment. In order to learn the distribution, we compared serum FDP aldolase with AFP -. AUI\ AST, respectively. Results: Serum levels of FDP aldolase in HCC were higher than the controls pre-treatment . Serum levels of FDP
aldolase released by ethanol injection were increased (P < 0.05) after the first PEI and thereafter decreased just like the wave. After the eighth PEI, it came back to the levels of pre-treatment. In group RF, serum levels of FDP aldolase were increased after twenty-four hours, and then descend straightly (P < 0.05); It came back in pre-treatment after seven days. Changes in serum levels of FDP Aldolase indicated tumor tissue necrosis in HCC. Serum levels of AFP were decreased after treatment ,and there were significant different between pre- and post-treatment, it also indicating adequate tumor tissue necrosis. The difference between activitise of serum FDP aldolase and ALT\ AST were significance(P < 0.05) at each treatment. In PEI group, Serum levels of ALT> AST were elevated after repeated PEI from first to fourth time. Compared with pre-treatment, it had significantly different (P < 0.05) . After the fifth PEI, Serum levels of ALT> AST were similar to pre-treatment. In RF group , Serum levels of AUI\ AST were highest in the first day after treatment, and then they were progressive decreased in the third and fifth day, but still had signifficanl different (P < 0.05) comparing with pre-treatment. After one week, serum levels of ALT> AST were similar to levels of pre-treatment. Conclusions: Serum levels of FDP aldolase have increased significantly in HCC, it is available to diagnosis of HCC. Measurement of FDP activities in serum
after ablation treatment is clinically useful to detect the degree of tumorous tissue damage ^specially for the case that AFP is negative. Serum levels of ALT- AST can be indicated lesion degree in tissue beside the tumor. Combining with ALT\ AST, Serun levels of FDP aldolase has great value in the judgement of necrosis in tumor tissue.
引文
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3 Lin SM, Lin DY, Lin CJ. Percutaneous ethanol injection therapy in 47 cirrhotic patients with hepatocellular carcinoma 5cm or less: a long-term result. Int J Clin Pract, 1999, 53(4):257～262.
4 Livraghi T, Bolondi L, Cottone M, et al. No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. J Hepatol, 1995, 22(4): 522～526.
5 张智坚，吴孟超，郭佳，等．B超引导经皮肝穿刺射频治疗肝癌，中国普通外科杂志，2001，10(2)：102～105．
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10 Shiina S, Tagawa K, Unuma T, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma ahistopathologic study. Cancer, 1991,68(7): 1524～1529
11 Sugiura N, Takam K, Ohto M, et al. Percutaneous intmtmnoural injection of ethanol under ulwasound imaging for treatment of small hepatocellular carcnoma. Acta Hepalol JPN, 1983, 24:920.
12 Livraghi T, Salmi A, Bolondi L. Small hepatocecullar carcinoma: Percutaneous alchool injextion results in 23 patients. Radiiology, 1988, 168(2):313～317
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14 Shiim S, Tagawa K, Niwa Y, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR, 1993, 160:1023～1028
15 Shiina S, Tagawa K, Unuma T, et al. Percutaneous ethanol injection therapy of hepatocellular carcinoma: analysis of 77 patients. AJR, 1990, 155:1221～1226
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20 Nativ O, Moskovitz B, Sabo E. Percutaneous ablation ofmadignant liver tumor in rabbits using low radiofrequency energy. J Exp Ther Oncol, 1996, 1:312～316.
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2 Lee MJ, Mueller PR, Dawson SL, et al. Percutaneous ethanol injection for the treatment of hepatic tumors: indications, mechanism of action, technique, and efficacy. AJR Am J Roentgenol, 1995, 164(1): 215～220.
3 Lin SM, Lin DY, Lin CJ. Percutaneous ethanol injection therapy in 47 cirrhotic patients with hepatocellular carcinoma 5cm or less: a long-term result. Int J Clin Pract, 1999, 53(4):257～262.
4 Livraghi T, Bolondi L, Cottone M, et al. No treatment, resection and ethanol injection in hepatocellular carcinoma: a retrospective analysis of survival in 391 patients with cirrhosis. J Hepatol, 1995, 22(4): 522～526.
5 张智坚，吴孟超，郭佳，等．B超引导经皮肝穿刺射频治疗肝癌，中国普通外科杂志，2001，10(2)：102～105．
6 Khan KN, Yatsuhashi H, Yamasaky K, et al. Prospective anylysis of risk factoes for early intahepatic recurrence of hepatocellular carcinoma following ethanol injection. J Hepatolog, 2000, 32: 269～278.
7 Ikeda K, Saitoh S, Koida I, et al. Diagnosis and follow-up of small hepatocellular carcinoma with selective intrarterial digital subtraction angiography. J Hepalology, 1993,17(6): 1003～1007.
8 Joseph F.B, Baumgarten D.A, Bemardino M.E. Hepatocellular cacinoma: CT appearance after percutaneous ethanol ablation therapy. Radiology, 1993,186:553～556.
9 李航，黎乐群．细针肝穿活检对原发性肝癌的诊断价值及针道种植的预防．中华肝脏病杂志，2000，8(5)：271．
10 Shiina S, Tagawa K, Unuma T, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma ahistopathologic study. Cancer, 1991,68(7): 1524～1529
11 Sugiura N, Takam K, Ohto M, et al. Percutaneous intmtmnoural injection of ethanol under ulwasound imaging for treatment of small hepatocellular carcnoma. Acta Hepalol JPN, 1983, 24:920.
12 Livraghi T, Salmi A, Bolondi L. Small hepatocecullar carcinoma: Percutaneous alchool injextion results in 23 patients. Radiiology, 1988, 168(2):313～317
13 林礼务，叶真，薛恩生，等．超声介入注射无水酒精治疗肝癌的量化研究．中国超声医学杂志，2001，16(7)：514～516
14 Shiim S, Tagawa K, Niwa Y, et al. Percutaneous ethanol injection therapy for hepatocellular carcinoma: results in 146 patients. AJR, 1993, 160:1023～1028
15 Shiina S, Tagawa K, Unuma T, et al. Percutaneous ethanol injection therapy of hepatocellular carcinoma: analysis of 77 patients. AJR, 1990, 155:1221～1226
16 Rhim H, Dodd Ⅱ Ⅰ GD. Radiofrequency theemal ablation of liver turnors. J Clin Ultrasound, 1999, 27:221～229.
17 Rissi S, Distas M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer. AJR, 1996, 167:759～768.
18 Mcgahan JP, Browing PD, Brock JM, et al. Hepatic ablation using radiofrequency electrocautery. [J].Invest, Radiology, 1990, 25:267～270.
19 Rossi S, Fomary F, Buscamini L. Percutaneous ultrasound-guided radiofrequency electrocautery for the treatment of small hepatocellular carcinoma. [J]. J Intervent Radiol, 1993, 8: 97～103.
20 Nativ O, Moskovitz B, Sabo E. Percutaneous ablation ofmadignant liver tumor in rabbits using low radiofrequency energy. J Exp Ther Oncol, 1996, 1:312～316.
21 Mcgahan JP, Brock JM, Tesluk H, et al. Hepatic ablation with use of mdiofrequency electrocautery in the animal model. J Vasc Interven Radiol, 1992, 3:291 4297.
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