广西医学

目的探讨血清可溶性T细胞免疫球蛋白黏蛋白3（sTIM-3）、人软骨糖蛋白39（YKL-40）水平与胆囊癌手术患者术后预后的相关性。方法纳入110例胆囊癌患者，根据术后随访情况将其分为预后良好组（65例）和预后不良组（45例）。比较两组的一般临床资料及术前血清sTIM-3、YKL-40水平。采用Kaplan-Meier法分析术前不同血清sTIM-3、YKL-40水平与胆囊癌患者术后预后的关系。采用多因素COX回归模型分析影响胆囊癌患者术后预后不良的因素。采用受试者工作特征曲线分析术前血清sTIM-3、YKL-40水平单独及联合预测胆囊癌患者术后预后不良的价值。结果与预后良好组比较，预后不良组肿瘤低/中分化程度、肿瘤直径＞3 cm、有淋巴结转移、胆总管浸润及肝脏浸润的患者比例，以及术前血清sTIM-3、YKL-40水平升高（P＜0.05）。sTIM-3、YKL-40低水平患者的3年生存率、3年无进展生存率分别高于sTIM-3、YKL-40高水平患者（P＜0.05）。术前血清sTIM-3水平升高、术前血清YKL-40水平升高、肿瘤低/中分化程度、淋巴结转移是胆囊癌患者术后发生不良预后的危险因素（P＜0.05）。术前血清sTIM-3、YKL-40水平单独及联合预测胆囊癌患者术后预后不良的曲线下面积（AUC）分别为0.782、0.785、0.903，两者联合的AUC优于单一指标的AUC（P＜0.05）。结论术前血清sTIM-3、YKL-40水平升高与胆囊癌患者术后预后不良密切相关，二者对胆囊癌手术患者术后预后有一定的预测价值，且二者联合预测的效能更高。

ObjectiveTo explore the correlation of serum soluble T cell immunoglobulin mucin 3 (sTIM-3) and human cartilage glycoprotein 39 (YKL-40) levels with postoperative prognosis in patients undergoing gallbladder carcinoma surgery. MethodsA total of 110 patients with gallbladder carcinoma were enrolled, and they were assigned to favorable prognosis group (65 cases) or adverse prognosis group (45 cases) according to postoperative follow-up status. The general clinical data, preoperative serum sTIM-3 and YKL-40 levels were compared between the two groups. The Kaplan-Meier method was applied to analyze the relation of preoperative different serum sTIM-3 and YKL-40 levels with postoperative prognosis in patients with gallbladder carcinoma. The multivariate COX regression model was employed to analyze the factors for affecting postoperative adverse prognosis in patients with gallbladder carcinoma. The receiver operating characteristic curve was used to analyze the value of preoperative serum sTIM-3 and YKL-40 levels for alone and jointly predicting postoperative adverse prognosis in patients with gallbladder carcinoma. ResultsCompared with the favorable prognosis group, the proportions of patients in low/medium differentiation degree of tumor, with tumor diameter larger than 3 cm, with presence of lymph nodes metastasis, with common bile duct infiltration, with liver infiltration in the adverse prognosis group were elevated, and levels of preoperative serum sTIM-3 and YKL-40 in the adverse prognosis group were also elevated (P＜0.05). Patients with low sTIM-3 and YKL-40 levels obtained higher 3-year survival rates and 3-year progress-free survival rates as compared with patients with high sTIM-3 and YKL-40 levels, respectively (P＜0.05). Elevated preoperative serum sTIM-3 and YKL-40 levels, low/medium differentiation degree of tumor, lymph nodes metastasis were the risk factors for patients with gallbladder carcinoma suffering from postoperative adverse prognosis (P＜0.05). Areas under the curve (AUC) of preoperative serum sTIM-3 and YKL-40 levels for alone and jointly predicting postoperative adverse prognosis in patients with gallbladder carcinoma were 0.782, 0.785, and 0.903, respectively, and AUC of combination of the two was superior to AUC of single indicator (P＜0.05). ConclusionThe elevations of preoperative serum sTIM-3 and YKL-40 levels are closely related to postoperative adverse prognosis in patients with gallbladder carcinoma, and the two exert a predictive value on postoperative prognosis in patients undergoing gallbladder carcinoma surgery to a certain extent, as well as the combination of the two exerts higher predictive efficiency.