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目的探讨血浆中血管内皮生长因子(VEGF)作为肝癌介入治疗(TACE或RFA)疗效判定指标的可行性,同时了解血浆VEGF水平与肝癌生物学特性的关系。方法16例患者中,13例行TACE治疗,3例行RFA治疗。术前1d,术后1、3、7、14、28d留取血样标本,分离血浆,酶联免疫吸附实验(ELISA)方法检测血浆VEGF水平;分析血浆VEGF水平与肝生化、甲胎蛋白及影像学特征间的关系。结果血浆VEGF水平在TACE治疗前1d,治疗后1、3、7、14、28d的均值分别为284.97±73.60、534.38±130.17、398.13±92.42、363.33±64.42、434.68±77.67和374.77±140.46,术后1d明显升高,与术前相比差异有显著性(P<0.05),术后3、7d较第1天明显下降,至术后14d略有升高;血浆VEGF水平在RFA治疗前1d、治疗后1、3、7、14、28d的均值分别为239.83±7.19、233.88±65.44、220.30±23.13、186.06±13.11、172.73±27.41和143.83±33.63,呈下降趋势。血浆中VEGF在合并门脉癌栓、动门脉瘘及远处转移患者中呈较高水平;与病灶位置、肿瘤染色情况、肿瘤有无包膜无明显相关关系(P>0.05);与AFP、GPT、AST、TB、ALB、PLT无明显相关性(P>0.05)。13例TACE治疗患者中疗效较好8例,疗效较差5例,两组间血浆VEGF水平术前及术后28d比较差异具有显著性(P<0.05),TACE治疗前后血浆VEGF变化率(术后28d/术前×100%)与术后病灶区碘油存积情况有明显相关性(r=-0.644,P=0.017)。结论血浆VEGF是一项独立于AFP的早期、敏感、有效的介入治疗疗效评价指标。
Objective To investigate the feasibility of using vascular endothelial growth factor (VEGF) in plasma as an indicator of efficacy in interventional therapy of hepatocellular carcinoma (TACE or RFA) and to understand the relationship between plasma VEGF and the biological characteristics of hepatocellular carcinoma. Methods Of the 16 patients, 13 underwent TACE and 3 received RFA. Blood samples were collected on day 1, day 1, day 7, day 7, day 7 and day 28 after operation. The levels of plasma VEGF were measured by enzyme linked immunosorbent assay (ELISA). The plasma levels of VEGF, Relationship between learning characteristics. Results The mean plasma VEGF levels at 1 day before TACE and at 1, 3, 7, 14 and 28 days after treatment were 284.97 ± 73.60, 534.38 ± 130.17, 398.13 ± 92.42, 363.33 ± 64.42, 434.68 ± 77.67 and 374.77 ± 140.46 respectively (P <0.05). After 3 days and 7 days, it decreased significantly from the first day and increased slightly to the 14th day after operation. The plasma level of VEGF was significantly higher at 1 day before RFA treatment , The mean values at 1, 3, 7, 14 and 28 days after treatment were respectively 239.83 ± 7.19, 233.88 ± 65.44, 220.30 ± 23.13, 186.06 ± 13.11, 172.73 ± 27.41 and 143.83 ± 33.63, showing a decreasing trend. Plasma VEGF in patients with portal vein thrombosis, arterial fistula and distant metastasis was higher; with the location of the lesion, tumor staining, with or without tumor capsule no significant correlation (P> 0.05); and AFP , GPT, AST, TB, ALB, PLT had no significant correlation (P> 0.05). Among the 13 patients with TACE, 8 patients were treated with good curative effect and 5 patients with poor curative effect. There was significant difference between the two groups before and 28 d after operation (P <0.05). The change rate of plasma VEGF before and after TACE Postoperative 28d / preoperative × 100%) and the area of postoperative lipiodol accumulation was significantly correlated (r = -0.644, P = 0.017). Conclusions Plasma VEGF is an early, sensitive and effective interventional therapeutic evaluation independent of AFP.