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血清YKL-40和AFP联合检测对肝细胞
癌患者手术预后判断的价值

作者：赵秀华 1 荆燕 2 朱成宝 2 张景遥 1

单位：1.山东大学济南市传染病医院肝病科山东济南 250021 2.山东大学济南市传染病医院检验科山东济南 250021

关键词：YKL-40 甲胎蛋白肝细胞癌预后

分类号：

出版年,卷(期):页码：2017,9(1):61-67

摘要：

摘要：目的探讨血清YKL-40和AFP联合检测对肝细胞癌患者手术预后判断的价值。方法回顾性分析
2011年7月至2012年12月于山东大学齐鲁医院肝胆外科接受根治性切除术的158例肝细胞癌患者的临床资
料，选择同期门诊健康体检者245例作为对照组。按血清YKL-40与AFP水平，将158例肝细胞癌患者分
成4组，A组（39例）：YKL-40、AFP均正常；B组（30例）：YKL-40正常、AFP升高；C组（42例）：
YKL-40升高、AFP正常；D组（47例）：YKL-40、AFP均升高。采用ELISA法检测肝细胞癌患者血清
YKL-40水平。生存分析采用Kaplan-Meier法绘制生存曲线，应用Log-rank进行检验，采用Cox比例风险模
型进行单因素及多因素分析。结果肝细胞癌患者血清YKL-40水平显著高于正常对照组（t = 3.307，P ＜
0.001），且与患者肿瘤数目和TNM分期密切相关（χ 2 = 9.885、5.667，P = 0.002、0.017）。Log-rank检
验显示4组间的总生存率和无复发生存率差异均有统计学意义（χ 2 = 9.350、10.982，P = 0.025、0.001）。
将组间总生存率无显著差异（χ 2 = 4.493，P = 0.128）的B、C、D组和并为E组（119例），组间无复发
生存率无显著性差异（χ 2 = 4.493，P = 0.128）的A、B、C组和并为F组（111例）。A组（YKL-40和AFP
均正常）总生存率显著高于E组（YKL-40和AFP单独或均升高）（χ 2 = 6.128，P = 0.014），D组（YKL-
40和AFP均升高）无复发生存率显著低于F组（YKL-40和AFP单独增高或均正常）（χ 2 = 11.275，P ＜
0.001）。多因素Cox回归分析显示，YKL-40与AFP联合指标是肝细胞癌的独立预后因素。结论 YKL-40
与AFP联合检测对肝细胞癌预后的判断更为准确，可作为肝细胞癌病理分期判断预后的有益补充。

Abstract: Objective To investigate the value of combined detection of serum YKL-40 and AFP on the
prognosis of patients with hepatocellular carcinoma after surgery. Methods Clinical data of 158 patients who
underwent radical resection of hepatocellular carcinoma admitted into Qilu Hospital of Shandong University
from July 2011 to December 2012 were retrospectively analyzed. Total of 245 healthy cases in the same period
were included as health control. According to the serum level of YKL-40 and AFP, patients with hepatocellular
carcinoma were divided into four groups: group A (39 cases): YKL-40 and AFP were both normal; group
B (30 cases): YKL-40 were normal and AFP elevated; group C (42 cases): YKL-40 elevated and AFP were
normal; group D (47 cases): YKL-40 and AFP both elevated. The serum YKL-40 level was determined by
enzyme-linked immunosorbent assay (ELISA). The survival curves were constructed using the Kaplan-Meier
method and compared by the log-rank test. The Cox proportional hazards regression model was performed to
identify the independent prognostic factors. Results The serum YKL-40 level in patients with hepatocellular
carcinoma after surgery was significantly higher than that in healthy individuals (t = 3.307, P ＜ 0.001), and
it was correlated with tumor number and TNM stages (χ 2 = 9.885, 5.667; P = 0.002, 0.017). The log-rank test

showed that there were significant differences among the four groups in the overall survival and recurrence-
free survival (χ 2 = 9.350, 10.982; P = 0.025, 0.001). The B, C and D groups which had no differences on their
overall survival (χ 2 = 4.493, P = 0.128) were merged into group E (119 cases) and the A, B and C groups
without differences on their recurrence-free survival (χ 2 = 4.493, P = 0.128) were merged into group F (111
cases). The overall survival in group A (normal YKL-40 and low AFP) were better (χ 2 = 6.128, P = 0.014)
than that of group E (YKL-40 and AFP solely or both elevated) and the rate of recurrence-free survival of
group D (elevated YKL-40 and high AFP group) were lower (χ 2 = 11.275, P ＜ 0.001) than that of group F
(YKL-40 and AFP solely elevated or were both normal). Multivariate Cox regression analysis showed that
the combination of YKL-40 and AFP was an independent prognostic factor for patients with hepatocellular
carcinoma. Conclusion The combination of YKL-40 and AFP serum YKL-40 could potently predict the
outcomes of patients with HCC and it may be a beneficial recruitment for TNM stages determination on
prognosis of patients after surgery.

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