血清APOC1和Klotho表达对肾癌后腹腔镜下肾部分切除术患者预后的预测价值

doi:10.11958/20240969

摘要/Abstract

摘要：

目的探讨载脂蛋白C1（APOC1）和Klotho表达预测肾癌后腹腔镜下肾部分切除术患者预后的临床价值。方法选择确诊为肾癌并行后腹腔镜肾部分切除术的患者80例，根据预后情况分为预后良好组（61例）和预后不良组（19例），另择健康体检者78例为对照组。收集一般临床资料，采用荧光定量聚合酶链式反应（qRT-PCR）检测血清APOC1、Klotho表达。采用Pearson法分析患者血清APOC1与Klotho水平的相关性，Cox回归分析影响患者预后的因素，受试者工作特征（ROC）曲线评估APOC1、Klotho水平对患者预后的预测效能。结果预后不良组和预后良好组临床分期和病理分级差异有统计学意义（P<0.05）。对照组、预后良好组和预后不良组血清APOC1表达水平依次升高，Klotho表达水平依次降低（P<0.05）。患者血清APOC1与Klotho表达水平呈负相关（r=-0.577，P<0.001）。Cox回归分析结果显示，Klotho表达水平降低、APOC1表达水平升高、病理分级2级、临床分期Ⅱ期是导致患者预后不良的独立危险因素（P<0.05）。ROC曲线结果显示，血清APOC1、Klotho联合预测肾癌患者术后预后不良的临床价值优于单一指标（P<0.05）。结论肾癌后腹腔镜下肾部分切除术预后不良患者血清APOC1水平升高，Klotho水平降低，二者联合对患者预后具有较高的临床价值。

关键词: 肾肿瘤, 载脂蛋白C1, Klotho, 后腹腔镜肾部分切除术, 预后

Abstract:

Objective To explore the clinical value of apolipoprotein C1 (APOC1) and Klotho expression levels in predicting the prognosis of patients with renal cancer after laparoscopic partial nephrectomy.Methods Eighty patients diagnosed as renal cell carcinoma and underwent laparoscopic partial nephrectomy were collected as the study subjects. According to the prognosis, patients were separated into the good prognosis group (61 cases) and the poor prognosis group (19 cases). Seventy-eight healthy individuals underwent physical examination were collected as the control group. The general clinical data of the subjects were collected, and serum levels of APOC1 and Klotho were tested and analyzed in three groups. Pearson method was applied to analyze the correlation between serum APOC1 and Klotho levels in patients. Cox regression was applied to analyze factors affecting the prognosis of patients. Receiver operating characteristic (ROC) curve was applied to analyze the predictive efficacy of APOC1 and Klotho levels on the prognosis of patients.Results There were significant differences in clinical stage and pathological grade between the poor prognosis group and the good prognosis group (P<0.05). Compared with the control group, the serum APOC1 levels were significantly increased in the good prognosis group and the poor prognosis group (P<0.05), while the Klotho expression levels were obviously reduced (P<0.05). And the serum APOC1 level in the control group, the poor prognosis group and the good prognosis group was increased successively (P<0.05), while the serum Klotho level was obviously decreased successively (P<0.05). The serum APOC1 expression level of patients was negatively correlated with Klotho level (r=-0.577, P<0.001). The Cox regression results showed that decreased expression level of Klotho and elevated expression level of APOC1, pathologic grading 2 and clinical staging stage Ⅱ were all independent risk factors for poor prognosis (P<0.05). The area under the curve (AUC) of serum APOC1 and Klotho levels, and their combined application in predicting poor postoperative prognosis in renal cancer patients was 0.863, 0.850 and 0.953, respectively, and the clinical value of combination of the two in predicting the prognosis of patients was superior to that of APOC1 and Klotho alone.Conclusion Patients with poor prognosis after retroperitoneal laparoscopic partial nephrectomy have a obvious increase in serum levels of APOC1 and a obvious decrease in serum level of Klotho. The combination of the two has high clinical significance in predicting the prognosis of patients with retroperitoneal laparoscopic partial nephrectomy.

Key words: kidney neoplasms, apolipoprotein C1, Klotho, retroperitoneal laparoscopic partial nephrectomy for renal cancer, prognosis

中图分类号:

R737.11

图/表 6

参考文献 19

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基因	引物序列（5′→3′）	产物大小/bp
APOC1	上游：AGGACAAGGCTCGGGAACTCAT	227
	下游：GATGTCACCCTTCACTCCTCA	227
Klotho	上游：ACCTGGTGGCGCACAC	168
	下游：TTGGCAAACCAACCTAGTACA	168
GAPDH	上游：GACCTGGTGGCGCACAC	202
	下游：GAAGATGGTGATGGGATTTC	202

基因	引物序列（5′→3′）	产物大小/bp
APOC1	上游：AGGACAAGGCTCGGGAACTCAT	227
	下游：GATGTCACCCTTCACTCCTCA	227
Klotho	上游：ACCTGGTGGCGCACAC	168
	下游：TTGGCAAACCAACCTAGTACA	168
GAPDH	上游：GACCTGGTGGCGCACAC	202
	下游：GAAGATGGTGATGGGATTTC	202

组别		n	性别				年龄/岁		病程/年		病理分级
组别		n	男		女		年龄/岁		病程/年		1级		2级
对照组		78	45（57.69）		33（42.31）		61.53±10.95		-		-		-
预后良好组		61	40（65.57）		21（34.43）		61.38±11.26		1.69±0.38		42（68.85）		19（31.15）
预后不良组		19	13（68.42）		6（57.69）		61.95±12.03		1.74±0.40		6（31.58）		13（68.42）
χ²、F或t			1.278				0.019		0.495		8.387^＊
组别	肿瘤类型					TNM分期				Scr/（μmol/L）		BUN/（mmol/L）
组别	透明细胞癌			乳头状肾细胞癌		Ⅰ期		Ⅱ期		Scr/（μmol/L）		BUN/（mmol/L）
对照组	-			-		-		-		73.19±10.86		6.96±0.98
预后良好组	52（85.25）			9（14.75）		39（63.93）		22（36.07）		106.85±13.37^a		9.83±1.35^a
预后不良组	15（78.95）			4（21.05）		7（36.84）		12（63.16）		121.43±15.29^ab		12.01±1.97^ab
χ²或F	0.086					4.351^＊				185.581^＊		159.837^＊

组别		n	性别				年龄/岁		病程/年		病理分级
组别		n	男		女		年龄/岁		病程/年		1级		2级
对照组		78	45（57.69）		33（42.31）		61.53±10.95		-		-		-
预后良好组		61	40（65.57）		21（34.43）		61.38±11.26		1.69±0.38		42（68.85）		19（31.15）
预后不良组		19	13（68.42）		6（57.69）		61.95±12.03		1.74±0.40		6（31.58）		13（68.42）
χ²、F或t			1.278				0.019		0.495		8.387^＊
组别	肿瘤类型					TNM分期				Scr/（μmol/L）		BUN/（mmol/L）
组别	透明细胞癌			乳头状肾细胞癌		Ⅰ期		Ⅱ期		Scr/（μmol/L）		BUN/（mmol/L）
对照组	-			-		-		-		73.19±10.86		6.96±0.98
预后良好组	52（85.25）			9（14.75）		39（63.93）		22（36.07）		106.85±13.37^a		9.83±1.35^a
预后不良组	15（78.95）			4（21.05）		7（36.84）		12（63.16）		121.43±15.29^ab		12.01±1.97^ab
χ²或F	0.086					4.351^＊				185.581^＊		159.837^＊

组别	n	APOC1	Klotho
对照组	78	1.04±0.08	1.02±0.09
预后良好组	61	1.18±0.17^a	0.83±0.15^a
预后不良组	19	1.53±0.23^ab	0.61±0.12^ab
F		91.198^＊	104.780^＊