血清亮氨酸氨基肽酶同工酶Ⅱ对原发性肝癌的诊断价值

STUDY ON THE VALUE OF SERUM LEUCINE AMINOPEPTIDASE ISOENZYME Ⅱ(LAP-Ⅱ) IN THE DIAGNOSIS OF PRIMARY HEPATIC CARCINOMA

目的探讨血清亮氨酸氨基肽酶(leucineam inopeptidase,LAP)同工酶Ⅱ(LAP-Ⅱ)对肝癌的诊断价值。方法使用不连续缓冲体系聚丙烯酰胺凝胶电泳分离血清LAP-Ⅱ。对95例肝癌和90例良性肝病患者血清LAP-Ⅱ进行检测,并与60例正常人及20例孕妇行对照研究;同步对比分析LAP总活性、AFP、GGT-Ⅱ(γ-谷氨酰转肽酶同工酶Ⅱ)。结果LAP-Ⅱ在正常人及孕妇中均为阴性。LAP-Ⅱ在肝癌及良性肝病患者中的阳性率分别为68.4%(65/95)和27.8%(25/90),差异有显著性(P<0.01),而LAP总活性在肝癌组与良性肝病组无差异(P>0.05);AFP≥50μg/L及AFP<50μg/L肝癌患者LAP-Ⅱ阳性率分别为70%(49/70)和64%(16/25);GGT-Ⅱ阳性及GGT-Ⅱ阴性肝癌患者LAP-Ⅱ阳性率分别为75.8%(47/62)和54.5%(18/33);单项LAP-Ⅱ、AFP、GGT-Ⅱ诊断肝癌的敏感性分别为68.4%、73.7%、65.3%;LAP-Ⅱ、AFP及GGT-Ⅱ联合检测诊断敏感性分别增至89.5%和84.2%;三项指标同步检测诊断敏感性达95.8%。结论LAP-Ⅱ为肝癌相对特异性标志物,有助于肝癌的诊断。LAP-Ⅱ、AFP和GGT-Ⅱ对肝癌有互补诊断价值,联合检测可提高肝癌的诊断敏感性。

Objective To study the value of LAP isoenzymes Ⅱ in the diagnosis of primary hepatic carcinoma （PHC）. Methods Serum LAP isoenzymes Ⅱ were determined in 95 cases with PHC, 90 cases with benign liver diseases, 20 cases with pregnancy and 60 healthy subjects. At the same time, serum LAP activities, alpha -fetoprotein（AFP） and -glutamyl transferase isoenzyme Ⅱ （GGT- Ⅱ） were measured to explore the value of LAP isoenzymes Ⅱ in the diagnosis of PHC. Results The positive rate of LAP - Ⅱ in PHC and benign liver diseases were 68.4% （65/95） and 27.8% （25/90） respectively （P 0. 01 ）. But there was no statistical difference in total LAP activity between PHC and benign liver diseases. The positive rate of LAP - Ⅱ was 70% （49/70） in PHC cases with AFP≥50 g/L, and 64% （16/25） in the cases with AFP 〈50 g/L. The positive rate of LAP- Ⅱ was 75.8% （47/62） in PHC cases with positive GGT - Ⅱ and 54.5% （18/33） in the cases with negative GGT - Ⅱ. The diagnostic sensitivity of LAP - Ⅱ, AFP and GGT - Ⅱ for diagnosis of PHC was 68.4%, 73.7% and 65.3% respectively. Combination of LAP - Ⅱ and AFP, or LAP - Ⅱ and GGT -Ⅱ may raise the diagnostic sensitivity to 89.5% or 84.2% respectively. Furthermore, the diagnostic sensitivity may increase to 95.8% by the simultaneous determination of LAP - Ⅱ, AFP and GGT - Ⅱ. Conclusion LAP - Ⅱ was a relative specific marker for PHC ; LAP - Ⅱ, AFP and GGT - Ⅱ were complementary to diagnosis of PHC, and combined determination of them may increase the diagnostic sensitivity to PHC.