原发性肝癌患者血清leptin,VEGF和AFP表达的意义

Clinical significance of serum leptin, vascular endothelial growth factor and alphafetoprotein expression in hepatocelluar carcinoma

目的:探讨HCC患者血清Lep,VEGF和AFP表达的临床意义.方法:用ELISA检测30例健康对照、31例肝硬化和146例HCC患者血清Lep,VEGF和AFP含量,分析Lep,VEGF和AFP及其联合检测对HCC的诊断、临床分期和预后的意义.结果:HCC患者血清Lep水平与BMI显著相关(r=0.64,P<0.01),且显著低于肝硬化组/健康对照组(19μg/Lvs35,27μg/L,P<0.05).随TNM分期增加和转移、复发,HCC血清Lep水平明显降低(P<0.05).HCC患者血清VEGF水平显著高于肝硬化组/健康对照组(398ng/Lvs179,167ng/L,P<0.01),VEGF和AFP间无相关性,二者对HCC诊断的敏感性和特异性分别为71.2%,73.3%和80.6%,83.9%,联合检测可提高诊断的敏感性(91.8%)和准确度(90.4%).HCC患者VEGF水平与肿瘤大小呈正相关(<3cm:237±96ng/L,>3cm:398±124ng/L,P<0.01),Ⅲ,Ⅳ期患者血清VEGF水平也明显高于Ⅰ,Ⅱ期患者(346±131,401±152ng/Lvs228±89,259±102ng/L,P<0.01),术后转移和复发患者血清VEGF水平明显升高(P<0.05).结论:血清Lep测定可判断HCC患者营养状况和预后,血清VEGF与AFP联合测定可作为诊断HCC和判断其预后的重要指标.

AIM： To explore the expression of serum leptin （Lep）, vascular endothelial growth factor （VEGF） and alpha-fetoprotein （AFP） and their clinical significances in hepatocelluar carcinoma （HCC）. METHODS： Enzyme-linked immunosorbent assay （ELISA） was used to detect serum Lep, VEGF and AFP levels in 146 patients with HCC, 31 patients with liver cirrhosis and 30 healthy controls. The correlations Lep, VEGF, and AFP expression with clinical indexes were analyzed. RESULTS： The serum Lep level was correlated with body mass index （BMI） in HCC patients （r = 0.64, P 〈 0.01）, and significantly lower than that in cirrhotic patients and healthy controls （19 μg/L vs 35, 27 μg/L, P 〈 0.05）. The serum Lep level in HCC patients was significantly decreased with upgrade of TNM stages, metastasis and recurrence （P 〈 0.05）. In comparison with that in cirrhotic patients and healthy controls, the serum VEGF level in HCC patients was significantly increased （398 ng/L vs 179, 167 ng/L, P 〈 0.01）. There was no correlation between VEGF and AFP expression. The sensitivity and specificity of VEGF were 71.2% and 80.6%, and those of AFP were 73.3% and 83.9%, respective- ly, in the diagnosis of HCC. However, the sensitivity was increased to 91.8%, while the accuracy reached 90.4% after the combined detection of VEGF and AFP was used. There was a relationship beween the level of serum VEGF and tumor size （〈3 cm： 237 ± 96 ng/L, 〉3 cm： 398 ± 124 ng/L, P 〈 0.01）. As compared with that of TNM Ⅰ, Ⅱ stage, the serum VEGF of TNM Ⅲ, Ⅳstage was obviously higher （346 ± 131, 401 ± 152 ng/L vs 228 ± 89, 259 ± 102 ng/L, P 〈 0.01）, and it also showed a significant elevation in the patients with metastasis and recurrent HCC （P 〈 0.01）. CONCLUSION： Nutrition status and prognosis of patients with HCC can be judged by serum Lep level, and the combined detection of serum VEGF and AFP may provide a significant marker for HCC diagnosis and prognosis.