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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2013, Vol. 02 ›› Issue (05) : 289 -293. doi: 10.3877/cma.j.issn.2095-3232.2013.05.004

所属专题： 文献；

临床研究

血清C-反应蛋白对进展期肝外胆管癌姑息性治疗患者预后的评估价值
马湘1, 张明进1, 曲林林1, 卢云1, 张炳远1,†()   
  1. 1. 266003　青岛大学医学院附属医院普外二科
  • 收稿日期:2013-05-20 出版日期:2013-10-10
  • 通信作者: 张炳远
  • 基金资助:
    山东省教育厅科技计划项目(BS20110004)

Value of serum C-reactive protein in the prognosis of patients with advanced extrahepatic cholangiocarcinoma who received palliative treatment

Xiang MA1, Ming-jin ZHANG1, Lin-lin QU1, Yun LU1, Bing-yuan ZHANG1,†()   

  1. 1. Second Department of General Surgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, China
  • Received:2013-05-20 Published:2013-10-10
  • Corresponding author: Bing-yuan ZHANG
  • About author:
    Corresponding author: ZHANG Bing-yuan, Email:
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马湘, 张明进, 曲林林, 卢云, 张炳远. 血清C-反应蛋白对进展期肝外胆管癌姑息性治疗患者预后的评估价值[J/OL]. 中华肝脏外科手术学电子杂志, 2013, 02(05): 289-293.

Xiang MA, Ming-jin ZHANG, Lin-lin QU, Yun LU, Bing-yuan ZHANG. Value of serum C-reactive protein in the prognosis of patients with advanced extrahepatic cholangiocarcinoma who received palliative treatment[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2013, 02(05): 289-293.

目的

探讨血清C-反应蛋白（CRP）对进展期肝外胆管癌姑息性治疗患者预后的评估价值。

方法

回顾性分析2006年5月至2011年6月青岛大学医学院附属医院收治的87例进展期肝外胆管癌姑息性治疗患者临床资料。其中男57例，女30例；年龄<60岁23例，年龄≥60岁64例。所有患者均签署知情同意书，符合医学伦理学规定。所有患者均接受减黄术、对症治疗，治疗前抽取空腹静脉血，采用免疫比浊法检测血清CRP水平。比较患者血清CRP水平与患者年龄、性别、发病时间、血红蛋白（Hb）、淋巴细胞、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酸转移酶（GGT）、白蛋白（ALB）、总胆红素（TB）、凝血酶原时间国际标准化率（PT-INR）、癌抗原19-9（CA19-9）、癌胚抗原（CEA）、肿瘤部位及治疗方法等一般临床资料的关系。患者出院后接受随访。定性资料的比较采用χ2检验。生存分析采用Kaplan-Meier法和Log-rank检验。预后危险因素分析采用Cox比例风险回归模型分析。

结果

年龄<60岁的血清CRP水平升高患者13例，年龄≥60岁者52例，差异有统计学意义（χ2=5.476，P<0.05）。血清CRP水平升高者1、3年累积生存率分别为8%、0%，血清CRP水平正常者1、3年累积生存率分别为22%、10%。血清CRP水平正常和升高患者的中位生存期分别为15.6、6.0个月，差异有统计学意义（χ2=4.038，P<0.05）。年龄<60岁和≥60岁患者的中位生存期分别为39.7、4.7个月，差异有统计学意义（χ2=11.732，P<0.05）。Cox回归多因素分析显示血清CRP水平升高与患者预后相关（RR=1.028，P<0.05）。

结论

血清CRP水平升高是进展期肝外胆管癌姑息性治疗患者预后不良的指标之一。

关键词: C反应蛋白质, 胆管肿瘤, 姑息疗法, 预后
Objective

To investigate the value of serum C-reactive protein (CRP) in the prognosis of patients with advanced extrahepatic cholangiocarcinoma who received palliative treatment.

Methods

Clinical data of 87 patients (57 males, 30 females; 23 cases of under 60 years old, 64 cases of 60 years old or above) with advanced extrahepatic cholangiocarcinoma who received palliative treatment from May 2006 to June 2011 in the Affiliated Hospital of Medical College, Qingdao University were retrospectively analyzed. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients received jaundice-reducing operations and symptomatic therapies. Before treatment, fasting venous blood samples were taken from patients to test the serum CRP levels by immunoturbidimetry. The relation was compared between serum CRP levels and clinical data, such as age, gender, onset time, hemoglobin (Hb), lymphocyte, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transferase (GGT), albumin (ALB), total bilirubin (TB), prothrombin time-international normalized ratio (PT-INR), cancer antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), tumor locations and therapies. The patients were followed up after being discharged from hospital. Qualitative data were compared by Chi-square test. The survival analysis was conducted by Kaplan-Meier method and Log-rank test. The prognostic risk factors were analyzed by Cox proportional hazards regression model.

Results

Increased serum CRP levels were observed in 13 cases of under 60 years old, and were observed in 52 cases of 60 years old or above, and there was significant difference between them (χ2=5.476, P<0.05). The 1-, 3-year cumulative survival rates were 8%, 0% respectively in patients with increased serum CRP levels, and were 22%, 10% respectively in patients with normal serum CRP levels. The median survival time was 15.6 months in patients with normal serum CRP levels and was 6.0 months in patients with increased serum CRP levels, and there was significant difference between them (χ2=4.038, P<0.05). The median survival time was 39.7 months in patients of under 60 years old and was 4.7 months in patients of 60 years old or above, and there was significant difference between them (χ2=11.732, P<0.05). Increased serum CRP levels were correlated with patients′ prognosis by Cox regression multi-factor analysis (RR=1.028, P<0.05).

Conclusion

Increased serum CRP level is one of the indicators of poor prognosis in patients with advanced extrahepatic cholangiocarcinoma who receive palliative treatment.

Key words: C-reactive protein, Bile duct neoplasms, Palliative care, Prognosis
表1 进展期肝外胆管癌姑息性治疗患者血清CRP水平升高与一般临床资料的关系（例）
参数 例数 CRP水平(mg/L) χ 2值 P值 参数 例数 CRP水平(mg/L) χ 2值 P值
? <5 ≥5 <5 ≥5
性别 ? ? ? 1.801 0.206 GGT(U/L) ? ? ? 1.708 0.281
? 男 57 17 40 ? ? ? <128 26 9 17 ? ?
? 女 30 5 25 ? ? ? ≥128 61 13 48 ? ?
年龄（岁） ? ? ? 5.476 0.027 ALB(g/L) ? ? ? 0.202 0.803
? <60 23 10 13 ? ? ? ≥35 36 10 26 ? ?
? ≥60 64 12 52 ? ? ? <35 51 12 39 ? ?
发病时间(d) ? ? ? 0.358 0.611 TB(μmol/L) ? ? ? 0.103 0.806
? <15 31 9 22 ? ? ? ? ? ? ? ? ?
? ≥15 56 13 43 ? ? ? <170 37 10 27 ? ?
Hb(g/L) ? ? ? 1.724 0.216 ? ≥170 50 12 38 ? ?
? <110 34 6 28 ? ? PT-INR ? ? ? 0.893 0.543
? ≥110 53 16 37 ? ? ? <1.0 69 19 50 ? ?
淋巴细胞 ? ? ? 0.011 1.000 ? ≥1.0 18 3 15 ? ?
? <1×109/L 23 6 17 ? ? CA19-9(kU/L) ? ? ? 0.391 0.597
? ≥1×109/L 64 16 48 ? ? ? <78 27 8 19 ? ?
ALT(U/L) ? ? ? 0.093 0.802 ? ≥78 60 14 46 ? ?
? <120 30 7 23 ? ? CEA(μg/L) ? ? ? 0.720 0.591
? ≥120 57 15 42 ? ? ? <3.4 26 5 21 ? ?
AST(U/L) ? ? ? 0.503 0.614 ? ≥3.4 61 17 44 ? ?
? <84 34 10 24 ? ? 肿瘤部位 ? ? ? 1.527 0.466
? ≥84 53 12 41 ? ?
ALP(U/L) ? ? ? 0.305 0.571 ? 上段 46 14 32 ? ?
? <250 20 6 14 ? ? ? 中段 8 2 6 ? ?
? ≥250 67 16 51 ? ? ? 下段 33 6 27 ? ?
图1 CRP水平正常患者与CRP水平升高患者的生存曲线
表2 进展期肝外胆管癌姑息性治疗患者预后的Cox回归多因素分析
变量 b SE(b) Wald χ2值 P值 RR 95%CI
男性 -0.603 0.530 1.292 0.256 0.547 0.194～1.547
年龄≥60岁 0.023 0.002 3.634 0.058 1.032 0.999～1.067
发病时间≥15 d 0.083 0.466 0.031 0.859 1.086 0.436～2.708
CRP≥5 mg/L 0.035 0.012 9.300 0.001 1.028 1.012～1.045
Hb<110 g/L -0.006 0.010 0.422 0.516 0.994 0.975～1.013
淋巴细胞<1×109/L 0.360 0.413 0.759 0.384 1.433 0.638～3.220
ALT≥120 U/L -0.001 0.004 0.071 0.790 0.999 0.991～1.007
AST≥84 U/L 0.004 0.004 0.799 0.371 1.004 0.996～1.012
ALP≥250 U/L 0.000 0.001 0.120 0.602 1.000 0.999～1.001
GGT≥128 U/L 0.000 0.001 0.156 0.693 1.000 0.998～1.001
ALB<35 g/L 0.086 0.085 1.016 0.314 1.090 0.922～1.288
TB≥170 μmol/L 0.003 0.002 1.459 0.224 0.951 0.938～1.025
PT-INR≥1.0 0.004 0.002 0.259 0.801 0.956 0.945～1.035
CA19-9≥78 kU/L 0.002 0.003 1.835 0.176 1.001 0.994～1.008
CEA≥3.4 μg/L 0.004 0.003 1.551 0.213 1.004 0.998～1.010
下段胆管癌 -0.095 0.245 0.152 0.697 0.909 0.563～1.468
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