肝病患者血清糖类抗原50变化的原因及临床意义

Mechanisms and Clinical Implications of Increased CA50 in Patients with Liver Disease

目的:探讨肝病患者血清糖类抗原50(CA50)升高的原因及其对肝癌诊断的临床意义。方法:采用免疫放射分析法(IRMA)测定急性肝炎、慢性肝炎、肝硬化及原发性肝癌共4组患者血清的CA50水平,并与肝功能、肝纤维化的相关指标作相关性分析。结果:血清CA50含量各肝病组间差异无统计学意义(P>0.05)。4组患者血清CA50含量皆与总胆红素(TBIL)、直接胆红素(DBIL)相关,慢性良性肝病组中CA50含量与丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、透明质酸(HA)、Ⅳ型胶原(CⅣ)相关,肝硬化组尚与γ谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)相关,P<0.05。结论:肝病血清CA50水平增高的原因:急性肝炎以肝内淤胆为主,慢性良性肝病可能由肝损害、肝组织结构改变、淤胆所致,肝癌可能主要与细胞恶变、抗原表达异常有关。CA50对肝癌诊断价值不大,动态观察CA50含量的变化有助于良、恶性肝病的区分。

Objective： To explore the causes of elevated serum CASO levels in patients with liver diseases and whether these play a role in diagnosis of liver cancers. Methods： The levels of serum CA50 in 29 cases with acute hepatitis, 40 cases with chronic hepatitis, 50 cases with hepatic cirrhosis and 32 cases with hepatocarcinoma were examined, and the relationship between serum CA50 levels and parameters of liver function and liver fibrosis were studied. Results： The serum CA50 levels in all patients with hepatic disease were positively correlated with TBIL and DBIL. Besides, significant corrections with ALT, AST, HA, C IV were found in chronic benign hepatic disease and with GGT, ALP in cirrhotic group. But in hepatocarcinoma, the levels of serum CASO were correlated with TBIL, DBIL alone. Conclusion： The mechanism for increased CA50 may be muhifactorial and depending on different liver diseases. Intrahepatic cholestasis seemed to be an important cause of abnormal CA50 in acute hepatitis. Liver damages, inflammatory infiltrates, arehitectural modifications of liver, cholestasis and liver dysfunction may result in the elevated levels of CA50 observed in chronic benign liver disease, while the abnormal CA50 expression due to the malignant cells may be mainly responsible for the increased CA50 in hepatocarcinoma.