乳酸脱氢酶与C反应蛋白/白蛋白比值对肝细胞癌患者经动脉化疗栓塞术预后的评估价值

doi:10.3877/cma.j.issn.2095-5782.2026.01.010

中华介入放射学电子杂志 ›› 2026, Vol. 14 ›› Issue (01) : 66 -71. doi: 10.3877/cma.j.issn.2095-5782.2026.01.010

论著

乳酸脱氢酶与C反应蛋白/白蛋白比值对肝细胞癌患者经动脉化疗栓塞术预后的评估价值

陆涛¹, 李毫¹, 朱帝文¹, 鲍应军¹, 李一帆¹, 顾俊鹏¹, 任伟新¹^,²^,^†(

)

¹　830054　新疆乌鲁木齐，新疆医科大学第一附属医院介入放射科
²　830054　新疆乌鲁木齐，新疆介入治疗临床医学研究中心

收稿日期:2025-07-16 出版日期:2026-02-25
通信作者: 任伟新
基金资助:
“天山英才”医药卫生高层次人才培养计划(TSYC202301B032); 新疆维吾尔自治区第二批“天池英才”青年博士引进计划项目

Prognostic Significance of Lactate Dehydrogenase and C-Reactive Protein-to-Albumin Ratio in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization

Tao Lu¹, Hao Li¹, Diwen Zhu¹, Yingjun Bao¹, Yifan Li¹, Junpeng Gu¹, Weixin Ren¹^,²^,^†()

¹ Department of Interventional Radiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
² Xinjiang Clinical Research Center for Interventional Therapy, Urumqi 830054, China

Received:2025-07-16 Published:2026-02-25
Corresponding author: Weixin Ren

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引用本文：

陆涛, 李毫, 朱帝文, 鲍应军, 李一帆, 顾俊鹏, 任伟新. 乳酸脱氢酶与C反应蛋白/白蛋白比值对肝细胞癌患者经动脉化疗栓塞术预后的评估价值[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 66-71.

Tao Lu, Hao Li, Diwen Zhu, Yingjun Bao, Yifan Li, Junpeng Gu, Weixin Ren. Prognostic Significance of Lactate Dehydrogenase and C-Reactive Protein-to-Albumin Ratio in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(01): 66-71.

目的

评估血清乳酸脱氢酶（lactate dehydrogenase, LDH）水平及C反应蛋白/白蛋白比值（C-reactive protein to albumin ratio, CAR）对肝细胞癌（hepatocellular carcinoma, HCC）患者经导管动脉化疗栓塞术（transarterial chemoembolization, TACE）后生存预后的预测价值。

方法

回顾性分析2017年1月至2024年12月接受≥3次TACE治疗的148例HCC患者。依据改良实体瘤疗效评价标准分为预后不良组（65例）与预后良好组（83例）。采用Kaplan-Meier法、Cox比例风险回归模型及受试者工作特征曲线分析相关指标。

结果

预后不良组患者的中位总生存期（overall survival，OS）为24个月，显著短于预后良好组37个月（P<0.001）。LDH≤250 U/L组中位OS（34个月）显著优于LDH>250 U/L组中位OS（16个月；P<0.001）。低CAR组中位OS显著长于高CAR组中位OS（P=0.004）。多因素Cox回归分析证实，巴塞罗那临床肝癌分期、LDH升高及CAR升高是OS缩短的独立危险因素（均P<0.05）。

结论

血清LDH和CAR水平可作为HCC患者TACE术后预后的有效预测指标，检测简便低廉，具有重要的临床应用价值。

关键词: 肝细胞癌, 动脉化疗栓塞, 乳酸脱氢酶, C反应蛋白/白蛋白比值

Objective

To evaluate the predictive value of serum lactate dehydrogenase (LDH) levels and C-reactive protein to albumin ratio (CAR) for survival outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).

Methods

A retrospective analysis was conducted on 148 HCC patients who received at least three TACE sessions between January 2017 and December 2024. According to the Modified Response Evaluation Criteria in Solid Tumors (mRECIST), patients were divided into the poor prognosis group (n=65) and the good prognosis group (n=83). Relevant indicators were analyzed using Kaplan-Meier method, Cox proportional hazards regression model and receiver operating characteristic curve.

Results

Kaplan-Meier analysis revealed that the median overall survival (OS) of patients in the poor prognosis group was 24 months, which was significantly shorter than 37 months in the good prognosis group (P<0.001). The median OS of the group with LDH≤250 U/L (34 months) was significantly better than that of the group with LDH>250 U/L (16 months; P<0.001). The median OS of the low-CAR group was significantly longer than that of the high-CAR group (P=0.004). Multivariate Cox regression analysis confirmed that Barcelona Clinic Liver Cancer (BCLC) stage, elevated LDH and elevated CAR were independent risk factors for shortened OS (all P<0.05).

Conclusion

Serum LDH and CAR levels can serve as effective prognostic predictors for HCC patients after TACE. These biomarkers are easy to detect and cost-effective, and have important clinical application value.

Key words: Hepatocellular carcinoma, Transarterial chemoembolization, Lactate dehydrogenase, C-reactive protein to albumin ratio

表1 两组患者一般临床资料分析

一般临床资料	TACE预后不良组(n=65)	TACE预后良好组(n=83)	P值
年龄(岁， $x ¯$ ±s)	57.70±11.10	58.30±11.10	0.989
性别[例(%)]			0.628
男	53(35.80)	65(43.90)
女	12(8.10)	18(12.20)
乙型肝炎病毒[例(%)]			0.190
有	53(37.20)	76(51.40)
无	10(6.80)	7(4.70)
肝硬化[例(%)]			0.977
有	44(29.70)	56(37.80)
无	21(14.20)	27(18.20)
腹水[例(%)]			0.672
有	13(8.80)	19(12.80)
无	52(35.10)	64(43.20)
肿瘤最大径[cm, M(Q₁，Q₃)]	4.90(3.10, 8.30)	5.97(3.50, 9.20)	0.471
肿瘤数目[例(%)]			0.322
1	25(16.80)	38(25.60)
2	9(6.10)	12(8.10)
≥3	31(21.10)	33(22.30)
肿瘤边界[例(%)]			0.709
类圆形	46(31.10)	61(41.20)
不规则形	19(12.80)	22(14.90)
门脉癌栓[例(%)]			0.057
有	26(17.70)	21(14.20)
无	39(26.40)	61(41.20)
肿瘤分布[例(%)]			0.703
单叶分布	45(30.40)	55(37.20)
双叶分布	20(13.50)	28(18.90)
BCLC分期[例(%)]			0.149
A	19(12.80)	36(24.30)
B	22(14.90)	30(20.30)
C	24(16.30)	20(13.50)
TBIL[μmol/L，M(Q₁，Q₃)]	17.10(14.10, 22.20)	18.03(13.90, 26.20)	0.399
CAR[M(Q₁，Q₃)]	0.20(0.10, 0.40)	0.20(0.07, 0.30)	0.028
ALT[U/L，M(Q₁，Q₃)]	45.90(26.60, 72.30)	38.10(26, 58)	0.144
AST[U/L，M(Q₁，Q₃)]	50.40(30.10, 68.70)	50(33, 82.20)	0.489
AFP[ng/mL，M(Q₁，Q₃)]	63.90(5.02, 699.30)	52.60(7.05, 726.50)	0.679
LDH[U/L，M(Q₁，Q₃)]	188.70(157.10, 224.00)	208(173.50, 267.40)	0.015

表1 两组患者一般临床资料分析

一般临床资料	TACE预后不良组(n=65)	TACE预后良好组(n=83)	P值
年龄(岁， $x ¯$ ±s)	57.70±11.10	58.30±11.10	0.989
性别[例(%)]			0.628
男	53(35.80)	65(43.90)
女	12(8.10)	18(12.20)
乙型肝炎病毒[例(%)]			0.190
有	53(37.20)	76(51.40)
无	10(6.80)	7(4.70)
肝硬化[例(%)]			0.977
有	44(29.70)	56(37.80)
无	21(14.20)	27(18.20)
腹水[例(%)]			0.672
有	13(8.80)	19(12.80)
无	52(35.10)	64(43.20)
肿瘤最大径[cm, M(Q₁，Q₃)]	4.90(3.10, 8.30)	5.97(3.50, 9.20)	0.471
肿瘤数目[例(%)]			0.322
1	25(16.80)	38(25.60)
2	9(6.10)	12(8.10)
≥3	31(21.10)	33(22.30)
肿瘤边界[例(%)]			0.709
类圆形	46(31.10)	61(41.20)
不规则形	19(12.80)	22(14.90)
门脉癌栓[例(%)]			0.057
有	26(17.70)	21(14.20)
无	39(26.40)	61(41.20)
肿瘤分布[例(%)]			0.703
单叶分布	45(30.40)	55(37.20)
双叶分布	20(13.50)	28(18.90)
BCLC分期[例(%)]			0.149
A	19(12.80)	36(24.30)
B	22(14.90)	30(20.30)
C	24(16.30)	20(13.50)
TBIL[μmol/L，M(Q₁，Q₃)]	17.10(14.10, 22.20)	18.03(13.90, 26.20)	0.399
CAR[M(Q₁，Q₃)]	0.20(0.10, 0.40)	0.20(0.07, 0.30)	0.028
ALT[U/L，M(Q₁，Q₃)]	45.90(26.60, 72.30)	38.10(26, 58)	0.144
AST[U/L，M(Q₁，Q₃)]	50.40(30.10, 68.70)	50(33, 82.20)	0.489
AFP[ng/mL，M(Q₁，Q₃)]	63.90(5.02, 699.30)	52.60(7.05, 726.50)	0.679
LDH[U/L，M(Q₁，Q₃)]	188.70(157.10, 224.00)	208(173.50, 267.40)	0.015

表2 TACE预后不良肝癌患者相关临床特征的单、多因素Cox回归分析

项目	单因素分析			多因素分析
项目	HR	95% CI	P值	HR	95% CI	P值
乙肝	0.913	0.389~2.143	0.834
肝硬化	0.811	0.474~1.386	0.443
腹水	0.845	0.538~2.132	0.845
肿瘤最大径	1.052	0.977~1.133	0.182
肿瘤数目	1.325	0.981~1.790	0.066
肿瘤边界	0.397	0.215~0.734	0.003	0.565	0.277-1.156	0.118
门脉癌栓	2.509	1.391~4.523	0.002	1.148	0.518-2.544	0.734
肿瘤分布	1.374	0.789~2.393	0.262
BCLC分期	2.164	1.489~3.146	<0.001	1.718	1.057-2.793	0.029
AFP	1.000	1.000~1.001	0.342
LDH	1.006	1.003~1.010	<0.001	1.004	1.000-1.008	0.027
CAR	4.618	2.012~10.599	<0.001	4.407	1.791-10.845	0.001
ALT	1.000	0.995~1.006	0.855
AST	1.003	0.999~1.007	0.097
Tbil	1.014	0.995~1.032	0.149

表2 TACE预后不良肝癌患者相关临床特征的单、多因素Cox回归分析

项目	单因素分析			多因素分析
项目	HR	95% CI	P值	HR	95% CI	P值
乙肝	0.913	0.389~2.143	0.834
肝硬化	0.811	0.474~1.386	0.443
腹水	0.845	0.538~2.132	0.845
肿瘤最大径	1.052	0.977~1.133	0.182
肿瘤数目	1.325	0.981~1.790	0.066
肿瘤边界	0.397	0.215~0.734	0.003	0.565	0.277-1.156	0.118
门脉癌栓	2.509	1.391~4.523	0.002	1.148	0.518-2.544	0.734
肿瘤分布	1.374	0.789~2.393	0.262
BCLC分期	2.164	1.489~3.146	<0.001	1.718	1.057-2.793	0.029
AFP	1.000	1.000~1.001	0.342
LDH	1.006	1.003~1.010	<0.001	1.004	1.000-1.008	0.027
CAR	4.618	2.012~10.599	<0.001	4.407	1.791-10.845	0.001
ALT	1.000	0.995~1.006	0.855
AST	1.003	0.999~1.007	0.097
Tbil	1.014	0.995~1.032	0.149

图1 预后不良组与预后良好组患者的生存曲线

图2 不同血清乳酸脱氢酶水平患者的生存曲线 LDH，血清乳酸脱氢酶。

图3 C反应蛋白/白蛋白比值诊断效能的ROC曲线分析

图4 低CAR组与高CAR组患者的生存曲线 CAR，C反应蛋白/白蛋白比值；低CAR组，CAR≤0.56；高CAR组，CAR>0.56。

[1]	Petruzziello A. Epidemiology of Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Related Hepatocellular Carcinoma[J]. Open Virol J, 2018, 12: 26-32.
[2]	Torre L A, Bray F, Siegel R L, et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65(2): 87-108.
[3]	Eggert T, Greten T F. Current Standard and Future Perspectives in Non-Surgical Therapy for Hepatocellular Carcinoma[J]. Digestion, 2017, 96(1): 1-4.
[4]	Wang Y, Deng T, Zeng L, et al. Efficacy and safety of radiofrequency ablation and transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma: A meta-analysis[J]. Hepatol Res, 2016, 46(1): 58-71.
[5]	Li S, Wang Q, Mei J, et al. Risk factors of extra-hepatic progression after transarterial chemoembolization for hepatocellular carcinoma patients: a retrospective study in 654 cases[J]. J Cancer, 2019, 10(20): 5007-5014.
[6]	Li Y, Lv J, Shi W, et al. Inflammasome Signaling: A Novel Paradigm of Hub Platform in Innate Immunity for Cancer Immunology and Immunotherapy[J]. Front Immunol, 2021, 12: 710110.
[7]	付建, 王敏, 乔春红, 等. C反应蛋白/白蛋白比率对ⅠB-ⅡA期宫颈鳞癌预后的预测价值[J]. 中国妇幼健康研究, 2021, 32(10): 1420-1424.
[8]	李金鹏, 石丛丛, 宋金龙, 等. 血清LDH的水平与肝癌介入治疗预后的关系[J]. 中国肿瘤临床, 2013, 40(6): 332-335.
[9]	Kudo M, Kawamura Y, Hasegawa K, et al. Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update[J]. Liver Cancer, 2021, 10(3): 181-223.
[10]	中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版)[J]. 磁共振成像, 2024, 15(6): 1-18.
[11]	Cai X, Chen Z, Chen J, et al. Albumin-to-Alkaline Phosphatase Ratio as an Independent Prognostic Factor for Overall Survival of Advanced Hepatocellular Carcinoma Patients without Receiving Standard Anti-Cancer Therapies[J]. J Cancer, 2018, 9(1): 189-197.
[12]	Zhang J P, Wang H B, Lin Y H, et al. Lactate Dehydrogenase Is an Important Prognostic Indicator for Hepatocellular Carcinoma after Partial Hepatectomy[J]. Transl Oncol, 2015, 8(6): 497-503.
[13]	Falfushynska H I, Gnatyshyna L L, Deneha H V, et al. Manifestations of Oxidative Stress And Molecular Damages in Ovarian Cancer Tissue[J]. Ukr Biochem J, 2015, 87(5): 93-102.
[14]	马庆霞, 顾澄, 严铃铃, 等. FAR、CAR、LSR、甲胎蛋白水平及微血管侵犯与原发性肝癌患者TACE术后生存时间的关系[J]. 国际检验医学杂志, 2023, 44(13): 1599-1603.
[15]	Shimizu T, Ishizuka M, Suzuki T, et al. The Value of the C-Reactive Protein-to-Albumin Ratio is Useful for Predicting Survival of Patients with Child-Pugh Class A Undergoing Liver Resection for Hepatocellular Carcinoma[J]. World J Surg, 2018, 42(7): 2218-2226.
[16]	Ren Y, Fan X, Chen G, et al. Preoperative C-reactive protein/albumin ratio to predict mortality and recurrence of patients with hepatocellular carcinoma after curative resection[J]. Med Clin (Barc), 2019, 153(5): 183-190.
[17]	Sun Q, Shang Y, Sun F, et al. Interleukin-6 Promotes Epithelial-Mesenchymal Transition and Cell Invasion through Integrin β6 Upregulation in Colorectal Cancer[J]. Oxid Med Cell Longev, 2020: 8032187.
[18]	赵培, 霍丽静, 谭鹤, 等. 酒精性脂肪肝和非酒精性脂肪肝血液生化学指标的临床研究[J]. 中国卫生检验杂志, 2017, 27(23): 3436-3438.

[1]	卢瑞芳, 林欣欣, 王昱, 许芊芊, 吴少虹, 王伟, 陈立达, 程美清. 2023年美国肝病研究学会肝细胞癌筛查指南的验证研究[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(11): 1046-1054.
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[5]	中华医学会器官移植学分会. 肝癌肝移植术后防治复发转移中国专家共识(2025版)[J/OL]. 中华移植杂志(电子版), 2025, 19(06): 385-397.
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[7]	崔梦玲, 孙文梅, 赵睿敏, 王家平. 合并微血管侵犯肝癌术后TACE联合治疗的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 160-166.
[8]	张龙, 徐伟, 孙善柯, 李文柱, 李俊达, 池涌泉, 宋进华, 王学浩, 成峰, 饶建华. 载药微球经动脉栓塞化疗在巨块型肝癌转化治疗中的疗效及安全性[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 28-35.
[9]	王利皓, 罗世超, 唐强, 尚栋良, 段少博, 卢冰, 李海, 薛飞. 仑伐替尼和PD-1抑制剂预处理联合TACE序贯治疗CNLC分期Ⅲ期肝癌疗效及安全性[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 868-874.
[10]	陈小坤, 杜顺达. 影像组学在肝细胞癌中的应用进展及挑战[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 97-100.
[11]	高增霞, 贺云飞, 赵娜. DCE-MRI联合Gd-EOB-DTPA MRI纹理特征对肝细胞癌经导管动脉化疗栓塞术后疗效的评估[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 108-113.
[12]	王甜, 张勇, 李苗红, 刘佳玥. MRI动态增强扫描联合CT能谱成像对肝细胞癌微血管侵犯的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(01): 6-12.
[13]	袁慧, 周芦忠, 汤鹤年, 潘菊花. LMR与PHR对射频消融术后肝细胞癌患者预后的评估[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(06): 635-641.
[14]	希龙夫, 李江涛. CXCL12及其受体CXCR4/CXCR7在肝脏相关疾病中的研究进展[J/OL]. 中华临床医师杂志(电子版), 2025, 19(09): 714-719.
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Prognostic Significance of Lactate Dehydrogenase and C-Reactive Protein-to-Albumin Ratio in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization

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Prognostic Significance of Lactate Dehydrogenase and C-Reactive Protein-to-Albumin Ratio in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization