肝癌伴抑郁患者血清CRP、hs-CRP水平变化及其对预后的影响

doi:10.11904/j.issn.1002-3070.2019.01.005

摘要/Abstract

摘要： 目的探讨抑郁对肝癌肝切除患者血清C反应蛋白(CRP)、超敏C反应蛋白(hs-CRP)水平及预后的影响。方法纳入肝癌行肝切除术患者251例,术前3天使用医院焦虑抑郁量表-抑郁亚量表(Hospital anxiety and depression scale,HADS-D)、9条目患者健康问卷(9-item patients health questionnaire,PHQ9)对患者进行抑郁评估,根据评分结果将患者分为抑郁组(n=95)和无抑郁组(n=156),比较两组患者术前血清CRP、hs-CRP、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平,生存分析Kaplan-Meier法比较两组患者术后无瘤生存期(DFS)和总生存期(OS)。结果抑郁组患者的血清CRP、hs-CRP、ALT、AST水平均高于无抑郁组(P＜0.05)。随访3.5年结果显示,164例(抑郁组65例,无抑郁组99例)患者出现复发或转移、47例(抑郁组22例,无抑郁组25例)死亡,抑郁组患者DFS、OS均显著低于无抑郁组(P＜0.05)。多因素Cox回归分析显分析显示,肝功能分级、BCLC分期、抑郁是影响肝癌预后的独立危险因素。Spearman相关分析显示,患者抑郁程度与血清CRP、hs-CRP水平呈正相关(P＜0.05),DFS、OS与血清CRP、hs-CRP水平呈负相关(P＜0.05)。结论抑郁可能介导血清CRP、hs-CRP水平升高,维持患者体内的炎症反应,导致肝功能损伤加重,ALT、AST水平升高,进而对肝癌患者预后造成不良影响。

关键词: 抑郁, 肝癌, 复发, 反应蛋白质, 预后

Abstract: Objective The Objective of this study was to investigate the effect of depression on serum levels of C-reactive protein(CRP)and high-sensitivity C-reactive protein(hs-CRP),and prognosis in liver cancer patients.Methods A total of 251 patients with liver cancer undergoing hepatectomy were enrolled.The hospital anxiety and depression scale(HADS-D)and 9-item patients health questionnaire(PHQ9)were assessed for depression before 3 days for surgery.Patients were divided into depression group(n=95)and non-depression group(n=156)according to the scores.Preoperative serum levels of CRP,hs-CRP,ALT and AST were measured and compared between the depression and non-depression groups.Survival analysis Kaplan-Meier method was used to compare the disease-free survival(DFS)and total survival(OS)between the two groups.Results The serum levels of CRP,hs-CRP,ALT and AST in the depression group were significantly higher than those in the non-depression group(P＜0.05).The follow-up of 3.5-year showed that 164 patients(65 in depression group and 99 in non-depression group)had recurrence or metastasis and 47 patients(22 in depression group and 25 in non-depression group)died.The DFS and OS in the depression group were significantly lower than those in the non-depression group(P＜ 0.05).Cox multiple regression analysis showed that liver function grading,BCLC staging and depression were independent risk factors for the prognosis of liver cancer.Spearman correlation analysis showed that patients′ degree of depression was positively correlated with serum levels of CRP and hs-CRP(P＜0.05),DFS and OS were negatively correlated with serum levels of CRP and hs-CRP(P＜0.05).Conclusion Depression may mediate elevated serum levels of CRP and hs-CRP,maintain inflammatory response in patients,lead to increased liver function damage,elevate levels of ALT and AST,and thus adversely affect the prognosis of patients with liver cancer.

Key words: Depression, Liver cancer, Recurrence, C-reactive protein, Prognosis

中图分类号:

R735.7

赵凤娟, 王琪, 任贇虹, 韦珏伶, 黎乐群, 赵新华, 唐娟, 游雪梅. 肝癌伴抑郁患者血清CRP、hs-CRP水平变化及其对预后的影响[J]. 实用肿瘤学杂志, 2019, 33(1): 27-33.

ZHAO Fengjuan, WANG Qi, REN Yunhong, WEI Jueling, LI Lequn, ZHAO Xinhua, TANG Juan, YOU Xuemei. Changes of serum CRP and hs-CRP levels in patients with liver cancer and depression and their influence on prognosis[J]. PRACTICAL ONCOLOGY JOURNAL, 2019, 33(1): 27-33.

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