髓源性免疫抑制细胞表达与肝动脉化疗栓塞术后肝衰竭的关系分析

张巍 邵明亮 刘文宗 张海丛 闫会敏 郑欢伟

[摘要]目的 探討肝动脉化疗栓塞术（TACE）术后肝衰竭的发生与髓源性免疫抑制细胞（MDSC）表达的关系。方法 选取2011年5月～2015年1月住院的237例乙肝病毒（HBV）相关原发性肝癌（PLC）患者作为研究对象，按照是否发生肝衰竭分为肝衰竭组（105例）与非肝衰竭组（132例），分析MDSC表达TACE术后肝衰竭的差异。按照肝衰竭程度分为肝衰竭轻度组（47例）、中度组（31例）、重度组（27例），按照肝衰竭预后分为死亡组（10例）与好转组（95例），比较各组MDSC表达差异。结果 PLC患者肝衰竭组的MDSC-m表型明显高于非肝衰竭组，差异有统计学意义（P=0.0405）。肝衰竭重度组的MDSC-m明显高于轻度组，差异有统计学意义（P<0.001）；肝衰竭死亡组的MDSC-m水平明显高于好转组，差异有统计学意义（P<0.01）。结论 肝动脉化疗栓塞术后肝衰竭发生、预后与MDSC高表达密切相关。

[关键词]肝癌；肝动脉化疗栓塞术；髓源性免疫抑制细胞

[中图分类号] R575.3 [文献标识码] A [文章编号] 1674-4721（2018）4（a）-0009-04

Analysis of the relationship between expression of myeloid-derived suppressor cell and liver failure after transcatheter arterial chemoembolization

ZHANG Wei SHAO Ming-liang LIU Wen-zong ZHANG Hai-cong YAN Hui-min ZHENG Huan-wei▲

Research Center，the Fifth Hospital of Shijiazhuang，Hebei Province，Shijiazhuang 050021，China

[Abstract]Objective To investigate the relationship between the occurrence of hepatic failure after transcatheter arterial chemoembolization （TACE） and the expression of myeloid-derived suppressor cell （MDSC）.Methods Altogether 237 patients with HBV-related primary liver cancer （PLC） who were hospitalized in our hospital from May 2011 to January 2015 were selected as the subject of this research，according to the the occurrence of liver failure，all patients were divided into 105 cases in liver failure group and 132 cases in non-liver failure group.The difference of MDSC expressions after TACE was analyzed.According to the degree of liver failure，all the patients were divided into mild liver failure group （47 cases），moderate group （31 cases），severe group （27 cases），according to the prognosis of liver failure，all the patients were divided into death group （10 cases） and improvement group （95 cases）.The difference of MDSC expressions in each group was compared.Results The MDSC-m phenotype of the PLC patients in liver failure group was significantly higher than that in the non-liver failure group，with significant difference （P=0.0405）.MDSC-m of severe liver failure group was significantly higher than that of mild group，with significant difference between the two groups （P<0.001）.MDSC-m level of the liver failure death group was significantly higher than that of improvement group，with significant difference between the two groups （P<0.01）.Conclusion The occurrence and prognosis of hepatic failure after TACE is closely related to the high expression of MDSC.

[Key words]Liver cancer；Transcatheter arterial chemoembolization；Myeloid-derived suppressor cell

原发性肝癌（primary liver cancer，PLC）是一种多因素综合形成的恶性肿瘤之一，原发于肝脏上皮细胞，分为肝细胞癌、肝胆管癌以及混合癌，其生存率低、恶性程度高[1]，病死率居恶性肿瘤的第3位。对于不能采取根治手段治疗的中晚期PLC患者，肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）治疗为非手术治疗中的首选方法[2]。研究发现乙肝病毒激活、免疫应激、肠道菌感染可能诱发肝衰竭，但是内在的机制仍未明确[3]。本研究旨在分析TACE治疗肝癌患者发生肝衰竭与髓源性免疫抑制细胞（myeloid-derived suppressor cells，MDSC）表达关联性，积极预防肝癌术后肝衰竭，或能及时干预临床治疗方案，提高患者生存率。

1资料与方法

1.1一般资料

选取2011年5月～2015年1月于石家庄市第五医院接受治疗的237例乙型肝炎病毒（HBV）相关PLC患者，按照是否发生肝衰竭分为肝衰竭组（105例）与非肝衰竭组（132例）。……