肝癌细胞RNA DNA及增殖指数的定量研究

Clinical significance of cellular RNA and DNA contents and PI in primary hepatocellular carcinoma

目的探讨ＲＮＡＤＮＡ含量及细胞增殖指数（ＰＩ）在原发性肝细胞癌（ＰＨＣ）中的应用价值．方法应用流式细胞分析技术，对６４例（男４６例，女１８例，年龄２４岁～７０岁，平均５１５岁）ＰＨＣ细胞ＲＮＡ，ＤＮＡ含量及ＰＩ进行了定量分析，并对患者进行了１年～５５年的随访．结果ＲＮＡ和ＤＮＡ指标对ＰＨＣ的诊断符合率分别为９３７％和７５０％，双指标联合应用诊断符合率为９６８％，ＲＮＡ指标更敏感．ＲＮＡ和ＤＮＡ含量与预后关系密切．ＤＮＡ含量随组织学分级的增高而增加（Ⅰ级为１２５，Ⅱ级为１４０，Ⅲ级为１５１，Ⅳ级为１６８），组织学各级之间ＤＮＡ含量均有显著性差异（Ｐ＜００５），提示ＤＮＡ含量可作为组织学分级的定量指标．ＤＮＡ倍体与年龄（＜５０岁，８２９％ｖｓ≥５０岁，６０９％；Ｐ＜００５）、ＨＣＶ感染（８１２％ｖｓ５６３％，Ｐ＜００５）密切相关，与性别、ＡＦＰ水平、ＨＢｓＡｇ及瘤体大小无关．ＰＩ值显著高于正常对照组（０３８±０１２ｖｓ０１０±００４，Ｐ＜００１），ＰＩ＞０４０者预后差．结论ＲＮＡ，ＤＮＡ含量及ＰＩ值可作为ＰＨＣ的诊断及判断预后的指标，ＲＮＡ及ＤＮＡ双指标联合应用价值更?

AIM To study the clinical significance of RNA and DNA contents and PI in patients with primary hepatocellular carcinoma (PHC). METHODS The cellular RNA and DNA contents and PI in 64 patients (46 males, 18 females) aged from 24 to 70 years with PHC were analysed by flow cytometry. All patients were followed up for 1～5 5 years. RESULTS The diagnostic accuracy rates of RNA index (RI) and DNA index (DI) were 93 7% and 75 0% in PHC respectively, and accuracy rate of combined RI and DI was 96 8%. Statistically the RI was significantly more sensitive than DI ( P <0 05). The incidence of aneuploid PHC was higher in patients under 50 years of age (82 9% vs 60 9%, P <0 05) and in those with infection of HCV (82 1% vs 56 3%, P <0 05). However, there was no significant correlation between DNA ploidy and patient′s sex, serum AFP level, HBsAg or tumor size (5cm as threshold). PI was much higher in PHC as compared to the normal control group (0 38±0 12 vs 0 10±0 04, P <0 01), and PHC with PI over 0 40 showed poor prognosis. The DI was correlated with the histologic grading (grade Ⅰ DI=1 25, grade Ⅱ DI=1 40, grade Ⅲ DI=1 51, grade Ⅳ DI=1 68). CONCLUSION Cellular DI may be an objective and precise quantitative marker in judging the degree, grade and differention of PHC. The combination of RI and PI may be more important for indicating the biological nature of PHC.