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Value of the inflammatory markers albumin, C-reactive protein, erythrocyte sedimentation rate, and interleukin-6 in predicting hepatocellular carcinoma with different types of portal vein thrombosis
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摘要:
目的 比较肝癌合并门静脉血栓(PVBT)与肝癌合并门静脉癌栓(PVTT)患者的生化及常规血液指标，探讨炎症指标在不同类型患者中的表达水平及临床意义。 方法 选取2016年1月—2020年12月于郑州大学第二附属医院诊治的肝癌合并PVBT患者51例(PVBT组)，肝癌合并PVTT患者37例(PVTT组)，随机选取同期住院的肝癌未合并门静脉栓子患者50例作为对照组。收集比较3组患者的一般临床资料、实验室检查结果等。计数资料组间比较采用χ2检验或Kruskal-Wallis秩和检验; 符合正态分布的计量资料组间比较采用单因素方差分析; 非正态分布的计量资料组间比较采用Kruskal-Wallis秩和检验。绘制ROC曲线评价Alb、CRP、ESR及IL-6在PVBT组与PVTT组的表达水平，计算ROC曲线下面积(AUC)，分析各项指标对不同类型栓子的预测价值。 结果 3组一般资料及常规生化指标检查结果差异均无统计学意义(P值均＞0.05)，而炎症指标Alb、CRP、血沉(ESR)及IL-6在3组间差异均有统计学意义(H值分别为10.207、24.465、8.917、37.584，P值分别为0.006、＜0.001、0.012、＜0.001)，进一步两组间比较提示，PVTT组Alb水平显著低于PVBT组与对照组，CRP、ESR及IL-6水平显著高于PVBT组与对照组，PVBT组CRP、IL-6水平显著高于对照组(P值均＜0.05)。ROC曲线提示PVTT组Alb、CRP、ESR及IL-6的AUC分别为0.659、0.826、0.679、0.873，PVBT组AUC分别为0.508、0.635、0.503、0.701。 结论 在肝癌伴PVTT患者中炎症指标IL-6、CRP、ESR高表达，Alb低表达，且预测价值依次递减; 而在肝癌伴PVBT患者中IL-6、CRP、ESR表达相对较低，Alb表达较高，其中IL-6、CRP对PVBT有一定的预测价值，ESR、Alb的预测价值不高。 Abstract:Objective To investigate the biochemical and routine blood parameters in hepatocellular carcinoma (HCC) patients with portal vein blood thrombus (PVBT) or portal vein tumor thrombosis (PVTT), as well as the expression level and clinical significance of inflammatory indices in patients with different types of PVBT. Methods A total of 51 HCC patients with PVBT and 37 HCC patients with PVTT who were diagnosed and treated in The Second Affiliated Hospital of Zhengzhou University from January 2016 to December 2020 were enrolled as PVBT group and PVTT group, respectively, and 50 HCC patients without portal vein thrombosis who were hospitalized during the same period of time were enrolled as control group. General clinical data and laboratory test results were collected from the three groups. The chi-square test or the Kruskal-Wallis rank sum test was used for comparison of categorical data between groups; a one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis rank sum test was used for comparison of non-normally distributed continuous data between groups. The receiver operating characteristic (ROC) curve was plotted to investigate the expression levels of albumin (Alb), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6) in the PVBT group and the PVTT group, and the area under the ROC curve (AUC) was calculated to analyze their value in predicting different types of thrombosis. Results There were no significant differences in general data and conventional biochemical parameters between the three groups (all P > 0.05), while there were significant differences in the inflammatory indices Alb, CRP, ESR, and IL-6 between the three groups (H=10.207, 24.465, 8.917, and 37.584, P=0.006, P < 0.001, P=0.012, and P < 0.001), and further analysis between two groups showed that the PVTT group had a significantly lower level of Alb and significantly higher levels of CRP, ESR, and IL-6 than the PVBT group and the control group, and the PVBT group had significantly higher levels of CRP and IL-6 than the control group (all P < 0.05). The ROC curve analysis showed that Alb, CRP, ESR, and IL-6 had an AUC of 0.659, 0.826, 0.679, and 0.873, respectively, in the PVTT group, as well as an AUC of 0.508, 0.635, 0.503, and 0.701, respectively, in the PVBT group. Conclusion HCC patients with PVTT tend to have high expression levels of the inflammatory indices IL-6, CRP, and ESR and a low expression level of Alb, and their predictive value decreases successively, while HCC patients with PVBT tend to have relatively low expression levels IL-6, CRP, and ESR and a relatively high expression level of Alb. IL-6 and CRP have a certain value in predicting PVBT, while ESR and ALB have little predictive value. -
Key words:
- Carcinoma, Hepatocellular /
- Venous Thromboembolism /
- Inflammatory Markers
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表 1 3组患者一般资料比较
指标 PVBT组(n=51) PVTT组(n=37) 对照组(n=50) 统计值 P值 男[例(%)] 32(62.7) 24(64.9) 30(60.0) χ2=0.221 0.896 年龄(岁) 61.06±11.53 62.68±10.62 61.20±10.87 F=0.267 0.766 病因[例(%)] χ2=0.323 0.851 病毒性 39(76.5) 30(81.1) 40(80.0) 非病毒性 12(23.5) 7(18.9) 10(20.0) Child-Pugh分级[例(%)] H=0.708 0.702 A级 24(47.1) 18(48.6) 27(54.0) B级 16(31.4) 11(29.7) 15(30.0) C级 11(21.6) 8(21.6) 8(16.0) 
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表 2 3组实验室检查结果比较
指标 PVBT组(n=51) PVTT组(n=37) 对照组(n=50) 统计值 P值 ALT(U/L) 56 (38~69) 49(35~72) 39(20~68) H=5.518 0.063 AST(U/L) 82(60~98) 83(68~93) 84(52~94) H=0.532 0.767 Alb(g/L) 33.2(31.0~36.0) 30.7(28.6~33.3)1) 34.9(29.7~38.3)2) H=10.207 0.006 TBil(μmol/L) 27.3(17.6~38.5) 26.4(16.9~36.8) 25.5(16.8~32.1) H=0.429 0.807 RBC(1012/L) 2.95(2.24~3.38) 3.13(2.42~3.64) 3.23(2.58~3.67) H=3.904 0.142 PLT(109/L) 89(74~103) 94(84~109) 106(77~149) H=4.500 0.105 WBC(109/L) 6.63(3.89~8.88) 7.16(4.93~9.16) 7.47(4.01~8.96) H=1.012 0.603 NE% 71.0(64.0~83.6) 73.4(63.8~81.5) 67.9(59.5~80.6) H=1.085 0.581 LY% 21.0(10.7~27.2) 20.0(12.5~28.5) 21.3(11.8~33.2) H=1.648 0.439 MO% 6.02±2.46 5.76±2.41 5.55±2.13 F=0.267 0.604 CRP(mg/L) 10.30(6.30~27.47) 22.80(12.67~33.52)1) 8.31(6.15~13.20)1)2) H=24.465 ＜0.001 ESR(mm/h) 22(15~36) 31(24~49)1) 22(17~30)2) H=8.917 0.012 IL-6(pg/ml) 7.61(4.64~14.88) 15.60(7.22~25.51)1) 4.28(2.81~7.06)1)2) H=37.584 ＜0.001 注：与PVBT组比较，1)P＜0.05;与PVTT组比较，2)P＜0.05。
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