肝细胞癌患者脂代谢异常的特征、脂肪酸结合蛋白的表达及其临床意义

Clinical significance of the characteristic of abnormal lipid metabolism and the expression of liver fatty acid binding protein in patients with hepatocellular carcinoma

摘要:

目的 探讨肝细胞癌（HCC）患者脂代谢异常的特征、脂肪酸结合蛋白（L-FABP）表达情况及其临床意义。方法 选取2020年1月—2022年9月武汉市中西医结合医院确诊的60例肝细胞癌患者作为HCC组、60例肝硬化患者作为肝硬化组，选取同期来该院体检的60例健康者作为对照组。对比各组患者血清载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、乳酸脱氢酶（LDH）、碱性磷酸酶（ALP）、胆碱酯酶（CHE）、总胆红素（TBIL）、L-FABP表达变化，并按照Child-pugh分级标准将HCC组患者进行分层比较。结果 HCC组、肝硬化组患者的ApoA水平低于对照组（P <0.05），HCC组的ApoA、ApoB、ApoA/ApoB水平高于肝硬化组（P <0.05）；肝硬化组患者的ApoB、HDL-C水平均低于对照组和HCC组（P <0.05），肝硬化组的TG、TC、LDL-C水平均高于对照组和HCC组（P <0.05）。HCC组、肝硬化组ALT、AST、LDH、ALP、TBIL水平高于对照组（P <0.05），CHE低于对照组（P <0.05）；HCC组患者的TBIL值低于肝硬化组（P <0.05）。HCC组L-FABP阳性率高于肝硬化组、对照组（P <0.0125）；肝硬化组与对照组患者的L-FABP阳性率比较，差异无统计学意义（P >0.0125）。肝功能Child-pugh分级C级患者ApoA、ApoA/ApoB、HDL-C低于A、B级患者（P <0.05），C级患者TG、LDL-C高于A、B级患者（P <0.05）。肝功能Child-pugh分级C级患者ALT、AST、LDH、TBIL高于A、B级患者（P <0.05），CHE低于A、B级患者（P <0.05）。肝功能Child-pugh分级C级患者L-FABP阳性率高于A、B级患者（P <0.05）。结论 HCC患者存在一定程度的脂代谢功能减弱、L-FABP表达增强的特征，且HCC与患者肝功能受损程度有一定的关系。

Abstract:

Objective To investigate the clinical significance of the characteristic of abnormal lipid metabolism and the expression of liver fatty acid binding protein (L-FABP) in patients with hepatocellular carcinoma (HCC).Methods Sixty patients with hepatocellular carcinoma (HCC) diagnosed in Wuhan Hospital of Traditional Chinese and Western Medicine from January 2020 to September 2022 were included as the HCC group, 60 patients with liver cirrhosis were selected as the cirrhosis group, and 60 volunteers undergoing health checkup in the hospital during the same period were enrolled as the control group. The changes in the serum levels of apolipoprotein A (ApoA), apolipoprotein B (ApoB), triacylglycerol (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), cholinesterase (CHE), total bilirubin (TBIL), and L-FABP were compared among the groups, and were further compared among the subgroups in HCC patients stratified via the Child-Pugh classification.Results The levels of ApoA in the HCC group and the cirrhosis group were lower than those in the control group (P < 0.05). The levels of ApoA, ApoB, and ApoA/ApoB in the HCC group were higher than those in the cirrhosis group (P < 0.05). The levels of ApoB and HDL-C in the cirrhosis group were lower than those in the control group and the HCC group (P <0.05). The levels of TG, TC, and LDL-C in the cirrhosis group were higher than those in the control group and the HCC group (P < 0.05). The levels of ALT, AST, LDH, ALP and TBIL in the HCC group and the cirrhosis group were higher than those in the control group (P < 0.05), while the level of CHE in the HCC group and the cirrhosis group was lower than that in the control group (P < 0.05). The level of TBIL in the HCC group was lower than that in the cirrhosis group (P< 0.05). The positive rate of L-FABP in the HCC group was higher than that in the cirrhosis group and the control group (P < 0.0125). There was no difference in the positive rate of L-FABP between the cirrhosis group and the control group (P > 0.0125). The levels of ApoA, ApoA/ApoB, and HDL-C in patients with Child-Pugh class C were lower than those in patients with Child-Pugh class A and B (P < 0.05). The levels of TG and LDL-C in patients with Child-Pugh class C were higher than those in patients with Child-Pugh class A and B (P < 0.05). The levels of ALT, AST, LDH, and TBIL in patients with Child-Pugh class C were higher than those in patients with Child-Pugh class A and B (P < 0.05), whereas the level of CHE in patients with Child-Pugh class C was lower than that in patients with Child-Pugh class A and B (P < 0.05). The positive rate of L-FABP in patients with Child-Pugh class C was higher than that in patients with Child-Pugh class A and B (P < 0.05).Conclusions HCC patients exhibit dysfunction in lipid metabolism to some extent. The expression of L-FABP is enhanced in HCC patients and related to the severity of liver impairment.