摘要
目的 探究原发性肝癌(PHC)患者在高强度聚焦超声(HIFU)治疗前后热休克蛋白 70(HSP70)、多效生长因子(PTN)、异常凝血酶原Ⅱ(PIVKA-Ⅱ)水平变化及对早期复发的影响和预测效能.方法 选取 2021 年 1月—2023 年1 月收治的PHC 120 例,均行HIFU治疗,根据术后 6 个月是否复发分为复发组(26 例)与未复发组(94例).比较2 组临床资料、治疗前后血清HSP70、PTN、PIVKA-Ⅱ水平及变化值(ΔHSP70、ΔPTN、ΔPIVKA-Ⅱ值),分析ΔHSP70、ΔPTN、ΔPIVKA-Ⅱ与HIFU治疗后早期复发的相关性,并评价预测效能.结果 2 组治疗后血清 HSP70、PTN、PIVKA-Ⅱ水平较治疗前下降(P＜0.05);复发组治疗前、治疗后血清HSP70、PTN、PIVKA-Ⅱ水平高于未复发组(P＜0.01).复发组血清ΔHSP70、ΔPTN、ΔPIVKA-Ⅱ值低于未复发组(P＜0.01).Spearman相关性分析显示,治疗前血清HSP70、PTN、PIVKA-Ⅱ与肿瘤直径、CNLC分期呈正相关,与分化程度呈负相关(P＜0.01).多因素Logistic回归分析显示,校正肿瘤直径、CNLC分期、分化程度因素前后血清ΔHSP70、ΔPTN、ΔPIVKA-Ⅱ值均与PHC患者HIFU治疗后早期复发独立相关(P＜0.01);血清ΔHSP70、ΔPTN、ΔPIVKA-Ⅱ值联合预测PHC患者HIFU治疗后早期复发的曲线下面积为0.916(95%CI:0.851,0.958),敏感度为0.923,特异度为0.872,优于三者单独预测.结论 PHC患者HIFU治疗前后HSP70、PTN、PIVKA-Ⅱ水平变化值与早期复发独立相关,且联合预测效能较高.
Abstract
Objective To investigate the changes in the levels of heat shock protein 70(HSP70),pleiotropic growth factor(PTN),and abnormal prothrombinogenⅡ(PIVKA-Ⅱ)in patients with primary hepatic carcinoma(PHC)before and after high-intensity focused ultrasound(HIFU)therapy,as well as their impact on early recurrence and predictive efficacy.Methods A total of 120 patients with PHC treated from January 2021 to January 2023 were selected,followed by HIFU ther-apy and divided into the recurrence group(n=26)and the non-recurrence group(n=94)according to whether they had re-currence at 6 months after surgery.Clinical data,serum levels of HSP70,PTN,and PIVKA-Ⅱbefore and after treatment,as well as their changes(ΔHSP70,ΔPTN,ΔPIVKA-Ⅱ values),were compared between the two groups.The correlation be-tween ΔHSP70,ΔPTN,ΔPIVKA-Ⅱ and early recurrence after HIFU therapy was analyzed,and the predictive efficacy was evaluated.Results After treatment,the levels of serum HSP70,PTN,and PIVKA-Ⅱin the two groups decreased compared with those before treatment(P＜0.05).The levels of serum HSP70,PTN,and PIVKA-Ⅱin the recurrence group before and after treatment were higher than those in the non-recurrence group(P＜0.01).The ΔHSP70,ΔPTN,and ΔPIVKA-Ⅱvalues in the recurrence group were lower than those in the non-recurrence group(P＜0.01).Spearman correlation analysis showed that before treatment,serum HSP70,PTN,and PIVKA-Ⅱ were positively correlated with tumor diameter and CNLC stage,and negatively correlated with differentiation degree(P＜0.01).Multivariate Logistic regression analysis showed that before and after adjusting for tumor diameter,CNLC stage,and differentiation degree factors,both serum ΔHSP70,ΔPTN,andΔPIVKA-Ⅱ levels were independently associated with early recurrence of PHC patients after HIFU therapy(P＜0.01).The area under the receiver operating characteristic(ROC)curve(AUC)of serum ΔHSP70,ΔPTN,and ΔPIVKA-Ⅱ values for predicting early recurrence of PHC patients after HIFU therapy was 0.916(95%CI:0.851,0.958),with a sensitivity of 0.923 and a specificity of 0.872,which was superior to predictions of the three indicators alone.Conclusion The changes in the levels of HSP70,PTN,and PIVKA-Ⅱbefore and after HIFU treatment in patients with PHC are independently associ-ated with early recurrence,and the combined predictive efficacy is high.
基金项目
石家庄市科学技术研究与发展计划(211460893)
维普
万方数据