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目的探讨原发性肝癌术后肝衰竭患者外周血单个核细胞(PBMCs)中CD163的阳性表达水平及其与患者预后的关系。方法选择2012年8月至2014年8月行肝切除术治疗的67例原发性肝癌患者作为研究对象,根据术后有无肝衰竭分为肝衰竭组(n=18)和无肝衰竭组(n=49),随访6个月后根据发生肝衰竭患者的预后分为死亡组(n=4)和存活组(n=14);并选择同期健康体检者80例作为对照组。采用流式细胞术对两组对象PBMCs中CD163的阳性表达水平进行测定和比较。结果肝衰竭组血小板计数、肝功能Child-pugh分级、术中出血量与无肝衰竭组比较差异有统计学意义(P<0.01,P<0.05)。PBMCs中CD163阳性表达水平,在肝衰竭组患者[(6.92±3.32)%]显著低于无肝衰竭组[(12.78±6.53)%,P<0.01]和对照组[(21.74±9.96)%,P<0.01];在肝衰竭晚期患者[(3.38±1.52)%]显著低于早期[(9.49±3.16)%,P<0.01]和中期患者[(6.87±2.91)%,P<0.05];在发生肝衰竭者中6个月后死亡组[(5.21±2.87)%]显著低于存活组[(9.16±2.39)%,P<0.05]。CD163评估肝衰竭患者预后的ROC曲线下面积(AUC)为0.846(95%CI 0.747~0.945)。结论肝癌术后肝衰竭患者PBMCs中CD163阳性表达水平显著降低,且与患者的病情程度及预后密切相关。
Objective To investigate the positive expression of CD163 in peripheral blood mononuclear cells (PBMCs) in patients with primary liver cancer after liver failure and its relationship with prognosis. Methods Sixty-seven patients with primary liver cancer undergoing hepatectomy between August 2012 and August 2014 were enrolled in this study. Patients with liver failure (n = 18) and without liver failure (n = 49). The patients were divided into death group (n = 4) and survival group (n = 14) according to the prognosis of patients with liver failure. Eighty healthy subjects were selected as the control group. The positive expression level of CD163 in PBMCs of the two groups was measured and compared by flow cytometry. Results There were significant differences in platelet count, Child-pugh classification of liver function and blood loss between liver failure group and non-liver failure group (P <0.01, P <0.05). The level of CD163 expression in PBMCs was significantly lower in patients with liver failure (6.92 ± 3.32% vs 12.78 ± 6.53%, P <0.01) and in the control group (21.74 ± 9.96% P <0.01]; P <0.01]; P <0.01] in the patients with advanced liver failure [(3.38 ± 1.52)%] Death after 6 months in those with liver failure [(5.21 ± 2.87)%] was significantly lower than that in survivors [(9.16 ± 2.39)%, P <0.05]. The area under the ROC curve (AUC) for CD163 in assessing the prognosis of patients with liver failure was 0.846 (95% CI 0.747 to 0.945). Conclusion The expression of CD163 in PBMCs of liver failure patients with hepatocellular carcinoma after liver failure is significantly decreased, which is closely related to the severity and prognosis of the patients.