外周血清5-羟色胺与血小板水平对肝细胞癌患者预后的影响

Abstract

摘要:

目的探究血小板及其内源性5-羟色胺 (5-HT) 与肝细胞癌患者预后的关系。方法回顾性分析西安交通大学第一附属医院2004年1月-2012年12月治疗的210例肝细胞癌患者资料,并根据血小板计数高低分为低血小板组 (n=129) 与高血小板组 (n=81) ,对比组间差异因素并进行预后分析。收集20例住院复发/转移肝癌患者及32例非复发/转移肝癌患者外周血标本,用ELISA法检测患者外周血清5-HT水平,血小板聚集仪检测血小板聚集率。血小板计数与肝癌临床病理因素之间的关系分析采用χ2检验;不同肝癌分组患者的外周血小板计数、聚集率及外周血5-HT水平比较采用Mann-Whitney U检验。血小板计数与生存期相关性以及5-HT水平与血小板计数、聚集率相关性分析采用一元线性回归。生存率及复发率分析采用Kaplan-Meier法,组间比较采用log-rank检验,影响肝癌患者预后因素分析使用Cox回归分析。结果不同血小板水平患者的年龄 (χ2=32. 304,P=0. 044) 、肿瘤大小 (χ2=35. 201,P=0. 001) 、肿瘤数目 (χ2=31. 304,P=0. 032) 、Child分级 (χ2=3...

Alternate abstract:

Objective To investigate the association of platelet and its endogenous 5-hydroxytryptamine( 5-HT) with the prognosis of patients with hepatocellular carcinoma( HCC). Methods A retrospective analysis was performed for the clinical data of 210 patients with HCC who were treated in The First Affiliated Hospital of Xi'an Jiaotong University from January 2004 to December 2012,and according to platelet count,the patients were divided into low platelet group and high platelet group. Related factors and prognosis were compared between two groups. Peripheral blood samples were collected from 20 patients with recurrent/metastatic liver cancer and 32 patients with non-recurrent/metastatic liver cancer; ELISA was used to measure the serum level of 5-HT,and the platelet aggregation instrument was used to measure platelet aggregation rate. The chi-square test was used to investigate the association between platelet count and the clinicopathological characteristics of liver cancer,and the Mann-Whitney U test was used to compare platelet count,platelet aggregation rate,and 5-HT level in peripheral blood between groups. A univariate linear regression analysis was used to investigate the association between platelet count and survival time,as well as the association of 5-HT level with platelet count and platelet aggregation rate. The Kaplan-Meier method was used to analyze survival rate and recurrence rate,the log-rank test was used for comparison between groups,and a Cox regression analysis was used to investigate the influencing factors for the prognosis of HCC patients. Results There were significant differences between the patients with different platelet counts in age( χ2= 32. 304,P = 0. 044),tumor size( χ2= 35. 201,P = 0. 001),number of tumors( χ2=31. 304,P = 0. 032),Child class( χ2= 31. 250,P = 0. 036),and TNM stage( χ2= 35. 201,P = 0. 001). The multivariate Cox regression analysis showed that age,alpha-fetoprotein( AFP) level on admission,platelet count on admission,and treatment modality were independent risk factors associated with overall survival( all P < 0. 05),while age,AFP level on admission,tumor size,platelet count on admission,and treatment modality were risk factors associated with recurrence-free survival( all P < 0. 05). The survival analysis showed that compared with the low platelet group,the high platelet group had a significantly lower overall survival rate( χ2= 34. 060,P < 0. 001) and a significantly higher recurrence rate( χ2= 31. 030,P < 0. 001). With the increase in platelet count,overall survival and recurrence-free survival tended to decrease( R2 OS= 0. 034,POS= 0. 007; R2 DFS= 0. 045,PDFS= 0. 002). Compared with the non-recurrent/metastatic liver cancer group,the recurrent/metastatic liver cancer group had significantly higher platelet count( U = 2. 950,P = 0. 041),platelet aggregation rate( U = 2. 363,P = 0. 043),and serum free 5-HT level( U = 3. 082,P = 0. 048). The correlation analysis showed that serum 5-HT level was positively correlated with platelet count and maximum platelet aggregation rate in peripheral blood( both P < 0. 05). Conclusion Platelet count is an independent risk factor for overall survival and recurrence/metastasis in patients with HCC. Peripheral 5-HT level is positively correlated with platelet count and platelet aggregation rate and may be one of the potential indices for predicting the prognosis of HCC patients.