联合检测甲胎蛋白和可溶性E-钙黏蛋白在原发性肝癌中的临床意义

Expression and significance of combined detection of soluble E-cadherin and alpha-fetoprotein in primary hepatic carcinoma

[摘要]目的探讨联合检测血清可溶性E-钙黏蛋白（sE—Cad）和甲胎蛋白（AFP）在原发性肝癌中的表达及临床意义。方法采用酶联免疫吸附（ELISA）检测45例原发性肝癌患者、40例肝良性占位病变患者和40例健康人sE—Cad水平，并用放射免疫法（RIA）检测AFP进行对照。结果原发性肝癌患者sE．Cad和AFP水平显著高于肝良性占位病变患者和健康人，sE—Cad水平与原发性肝癌TNM分期密切相关（P〈0．01），与肿瘤分级，有无门静脉癌栓、有无包膜相关（P〈0．05），与年龄、肿瘤大小无关（P〉0．05）。AFP水平与原发性肝癌TNM分期密切相关（P〈0．05），与年龄、肿瘤大小、肿瘤分级、有无门静脉癌栓、有无包膜相关无关（P〉0．05）。将sE-Cad为2100．g／ml作为肝癌诊断的临界值切点（cut-off）时，sE-Cad检测原发性肝癌的灵敏度和特异度达到最高，分别为88．7％和86．5．％，且与AFP比较差异有统计学意义（88．7％VS75．6％，86．5％VS79．4％，P〈0．05）；sE．Cad＋AFP联合检测可使敏感性提高到98．1％，特异性为80．8％。结论sE-Cad诊断原发性肝癌有较好的敏感性和特异性，sE-Cad水平可作为一种判断原发性肝癌预后预测因子。联合检测血清中的sE—cad和AFP可提高原发性肝癌的诊断价值。

Objective To detect the expression and its significance of combined detection of sol- uble E-cadherin （sE-Cad） and alpha-fetoprotein （AFP） in primary hepatic carcinoma （ PHC ） patients. Meth- otis Enzyme-linked immunosorbent assay（ELISA） method was used to detect the serum level of sEC in 45 cases of PHC,40 cases of liver benign tumor, and 40 cases of healthy people. The radioimmunoassay （RIA） method was used to detect the serum level of AFP in all as a comparison. Results The levels of sE-cad and AFP in PHC patients were significantly higher than those in two controls. The sE-Cad levels of PHC showed significant correlation with TNM staging（ P 〈 0.01 ）, Edmondson grade, the cancerous thrombi within the portal vein and the capsule of carcinoma （ P 〈 O. 05 ）, but not with age or the tumor size （ P 〉 O. 05 ）. AFP was only correlated with TNM staging （ P 〈 0.05 ）, but not with others factors （ P 〉 0.05 ）. When the cut-off value for sE-Cad was determined to be 2100ng/ml, the sensitivity and specificity of the sE-Cad was optimal. The difference between sE-Cad and AFP in the group of PHC was statistically signifi- cant（88.7% vs. 75.6% ,86.5. % vs. 79.4% ）. For combined detection of serum sE-Cad and AFP,the di- agnostic sensitivity was increased to 98.1% and the specificity was 80.8%. Conclusion The sE-Cad has higher sensitivity and specificity than AFP. The level of sE-Cad in patients is closely related with prognosis of PHC. The sensitivity of combined detection of sE-Cad and AFP is better than single test, and can improve PHC diagnosis.