肝癌患者血清中聚糖蛋白3检测的临床意义

Clinical significance of serum glypican-3 detection in liver cancer

目的探讨血清聚糖蛋白3（GPC3）在肝癌研究中的临床应用价值。方法应用生物素-链霉亲和素系统亲和力高的特点建立双抗体夹心酶联免疫吸附试验（ELISA）方法，检测681份不同人群血清中的GPC3。结果（1）肝硬化组（42．9％）、肝癌组（41．4％）、肝癌复发组（61．1％）患者血清GPC3阳性率与正常人组（4．1％）及乙肝组（8．6％）差异有统计学意义（P〈0．01）；肝细胞型肝癌组（HCC）血清GPC3阳性率（45．9％）高于胆管细胞型肝癌组（ICC）（20．9％）（P〈0．05）；HCC组中直径≤3cm的小肝癌及AFP≤20μ/L的肝癌血清中GPC3阳性率分别为36．0％、41．9％；AFP≤20μg／L且直径≤3cm的小肝癌患者血清GPC3阳性率为44．4％（4／9）。（2）联合血清AFP及GPC3，可将单独应用AFP时提示肝癌复发从77．7％提高N88．9％。（3）结肠癌肝转移病例血清中GPC3的阳性率为28．6％。（4）手术切除术前及术后2-16d内HCC患者血清中GPC3的变化多样。（5）24例HCC组织GPC3阳性20例，其中血清GPC3阳性率为50％。结论血清中GPC3的测定作为一种新的肿瘤标志物在肝癌的诊断特别是早期诊断、提示复发、转移及评价手术治疗效果中可能均有一定的意义。

Objective To study the clinical significance of serum glypican-3 （GPC3） in liver cancer research. Methods Based on the high affinity between biotin and streptavidin, pairs of polyantibody sandwich ELISA method was set up to detect serum GPC3 in 681 cases of liver cancer. Results （ 1 ） The positive rate of serum GPC3 in the groups of cirrhosis, liver cancer and recurrent liver cancer was 42.9% ,41.4% ,61.1% ,respectively ,obviously higher （P 〈0.01 ） than in the normal controls （4.1%） and HBV infection patients （ 8. 6% ）. The positive rate of serum GPC3 in hepatocellular carcinoma （45.9%） was higher than intrahepatic cholangiocellular carcinoma group （ 20.9% ） （ P 〈 0.05 ）. In the patients with HCC ≤3 cm in diameter and AFP≤20 μg/L,the positive rate of serum GPC3 was 36.0% and 41.9% , respectively. In small HCC with AFP≤20 μg/L,the positive rate of serum GPC3 was 44.4% （4/9）. （2） By detecting the serum AFP in combination with GPC3, recurrent liver cancer was indicated from 77.7% using AFP alone up to 88.9% ; （ 3 ） The positive rate of serum GPC3 was 28.6% in patients with liver metastasis; （4） The changes in srum GPC3 were diverse in HCC patients before and 2-16 days after operation; （5） Among 24 cases of HCC,20 cases were positive for tissue GPC3 and 12 cases for serum GPC3 ,respectively. Conclusion Detection of serum GPC3 could be a novel tumor marker for diagnosis especially early diagnosis in liver cancer, also it might be useful to indicate recurrence, metastasis and evaluate the outcome of operation.