原发性肝癌患者外周血清IL-6、IL-18和AFP水平变化对肺部感染的预测价值

摘要/Abstract

摘要： 目的探讨原发性肝癌患者外周血清IL-6、IL-18和AFP水平对肺部感染的预测价值。方法纳入2019年1月至2022年12月承德医学院附属医院收治的原发性肝癌患者118例。所有患者均接受肝动脉化疗栓塞术治疗,比较治疗后发生肺部感染组与未感染组IL-6、IL-18 、AFP水平及临床资料,分析上述3项外周血指标对原发性肝癌患者肺部感染的预测价值。结果 118例原发性肝癌患者中发生肺部感染26例(22.03%);感染组有肝癌破裂史患者占比高于未感染组(46.15%比21.74%),差异有统计学意义(P<0.05)。感染组外周血IL-6(70.54±21.49)pg/mL、IL-18(136.52±20.79)mg/L、AFP(35.04±5.32)ng/mL,高于未感染组的(47.76±16.31)pg/mL、(94.89±12.16)mg/L、(15.69±4.24)ng/mL,差异有统计学意义(P<0.05)。经logistic回归分析结果显示,外周血IL-6、IL-18、AFP水平、肝癌破裂史是原发性肝癌患者肺部感染的危险因素(OR=1.054、1.021、45.241、3.086,P<0.05)。外周血IL-6、IL-18、AFP及三者联合预测原发性肝癌患者肺部感染的ROC曲线下面积(AUC)分别为0.738、0.782、0.705、0.785。结论外周血IL-6、IL-18、AFP水平是原发性肝癌患者发生肺部感染的危险因素,对肺部感染具有一定预测价值。

关键词: 原发性肝癌, 肺部感染, 白细胞介素-6, 血清白介素 -18, IL-18 结合蛋白

Abstract: Objective To explore the predictive value of peripheral serum levels of interleukin-6 (IL-6), serum interleukin-18 (IL-18), and alpha fetoprotein (AFP) for pulmonary infection in patients with primary liver cancer. Methods 118 patients with primary liver cancer admitted to our hospital from January 2019 to December 2022 were included as the study subjects. All patients received hepatic artery chemoembolization treatment, and the incidence of pulmonary infection after treatment was recorded and divided into an infected group and an uninfected group. Clinical data and peripheral blood levels of IL-6, IL-18, and AFP were collected and compared between the two groups of patients upon admission. The predictive value of these three peripheral blood indicators for pulmonary infection in patients with primary liver cancer was analyzed. Results Out of 118 patients with primary liver cancer, 26 cases (22.03%) developed pulmonary infection. The proportion of patients with a history of liver cancer rupture in the infected group was higher than that in the uninfected group (46.15% vs. 21.74%), and the difference was statistically significant (P<0.05); The peripheral blood IL-6 [(70.54 ± 21.49) pg/mL], IL-18 [(136.52 ± 20.79) mg/L], and AFP [(35.04 ± 5.32) ng/mL] in the infected group were higher than those in the uninfected group [(47.76 ± 16.31) pg/mL, (94.89 ± 12.16) mg/L, (15.69 ± 4.24) ng/mL], and the difference was statistically significant (P<0.05). The results of logistic regression analysis showed that peripheral blood levels of IL-6, IL-18, AFP, and a history of liver cancer rupture were risk factors for pulmonary infection in patients with primary liver cancer (OR=1.054, 1.021, 45.241, 3.086, P<0.05). The receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) of peripheral blood IL-6, IL-18, AFP, and their combined prediction of pulmonary infection in patients with primary liver cancer were 0.738, 0.782, 0.705, and 0.785, respectively. Conclusion The sreum levels of IL-6, IL-18, and AFP are risk factors for pulmonary infection in patients with primary liver cancer, and have certain value in predicting pulmonary infection.

Key words: Primary liver cancer, Pulmonary infection, Interleukin-6, C-reactive protein, Procalcitonin

牛兴杰, 刘志慧, 崔凤梅, 张国民, 刘耀敏. 原发性肝癌患者外周血清IL-6、IL-18和AFP水平变化对肺部感染的预测价值[J]. 肝脏, 2025, 30(4): 471-475.

NIU Xing-jie, LIU Zhi-hui, CUI Feng-mei, ZHANG Guo-min, LIU Yao-min. Predictive value of changes of IL-6, IL-18, AFP levels in peripheral blood of patients with primary liver cancer on pulmonary infection[J]. Chinese Hepatolgy, 2025, 30(4): 471-475.

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参考文献

[1] Li X, Ramadori P, Pfister D,et al. The immunological and metabolic landscape in primary and metastatic liver cancer[J]. Nat Rev Cancer, 2021 ,21(9):541-557.
[2] McGlynn K A, Petrick J L, El-Serag H B. Epidemiology of hepatocellular carcinoma[J]. Hepatology,2021,73(11):4-13.
[3] Hamaya S, Oura K, Morishita A,et al. Cisplatin in liver cancer therapy[J]. Int J Mol Sci, 2023,24(13):108-158.
[4] 方颖慧,谭利利,吕良缘,等.中性粒细胞和血清IL-6水平对急性心肌梗死的诊断价值研究[J].婚育与健康,2024,30(06):25-27.
[5] 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志, 2017, 16(7):13.
[6] Rumgay H, Arnold M, Ferlay J,et al. Global burden of primary liver cancer in 2020 and predictions to 2040[J]. J Hepatol,2022,77(6):1598-1606.
[7] Zhou H, Song T. Conversion therapy and maintenance therapy for primary hepatocellular carcinoma[J]. Biosci Trends, 2021,15(3):155-160.
[8] Wang J, Xu H, Wang Y,et al. Efficacy and safety of drug-eluting bead TACE in the treatment of primary or secondary liver cancer[J]. Can J Gastroenterol Hepatol,2023,26(87);54-92.
[9] Yasuda K, Nakanishi K, Tsutsui H. Interleukin-18 in health and disease[J]. Int J Mol Sci. 2019 Feb 2;20(3):649. doi: 10.3390/ijms20030649.
[10] Fujinaka R, Urade T, Kido M, et al. Spontaneous rupture of splenic hilar lymph node metastasis from hepatocellular carcinoma[J]. Clin J Gastroenterol, 2024,17(3):557-562.
[11] Chearanai O, Plengvanit U, Asavanich C,et al. Spontaneous rupture of primary hepatoma: report of 63 cases with particular reference to the pathogenesis and rationale treatment by hepatic artery ligation[J]. Cancer,1983,51(8):15-32.
[12] 刘敏,李莉.白细胞介素-6在原发性肝癌中的研究进展[J].肝脏,2024,29(01):122-126.
[13] Peltonen R, Gramkow M H, Dehlendorff C, et al. Elevated serum YKL-40, IL-6, CRP, CEA, and CA19-9 combined as a prognostic biomarker panel after resection of colorectal liver metastases[J]. PLoS One, 2020,15(8):65-69.
[14] Rose-John S. Interleukin-6 family cytokines[J]. Cold Spring Harb Perspect Biol, 2018,10(2):28-41.
[15] Vecchié A, Bonaventura A, Toldo S, et al. IL-18 and infections: is there a role for targeted therapies?[J]. J Cell Physiol, 2021,236(3):1638-1657.
[16] 张付杰,姜德清,李大柱,等. 联合检测血清IL-6、IL-18及IL-18BP在原发性肝癌中的临床价值[J]. 中华全科医学,2022,10(8):1227-1228,1281.
[17] 钱丽媛,李长菲,罗云敬,等. 甲胎蛋白在肝癌的诊断和治疗中的研究进展[J]. 生物工程学报,2021,37(9):3042-3060.
[18] 朱嫦琳,陈展泽,李启欣. 基于决策曲线分析评估血清异常凝血酶原和甲胎蛋白在原发性肝癌中的诊断价值[J]. 实用医学杂志,2021,37(19):2524-2529.
[19] Hanif H, Ali M J, Susheela A T, et al. Update on the applications and limitations of alpha-fetoprotein for hepatocellular carcinoma[J]. World J Gastroenterol,2022,28(2):216-229.