小扁豆凝集素结合型甲胎异质体在肝癌诊断中的意义

Significance of Lens culinaris agglutinin-reactive alpha-fetoprotein in the diagnosis of hepatocellular carcinoma

目的探讨小扁豆凝集素结合型甲胎蛋白异质体(AFP-L3)在良恶性肝病鉴别诊断的临床价值。方法应用装有耦联了小扁豆凝集素(LCA)的微量离心柱分离185例肝病患者的AFP-L3,用时间分辨荧光免疫检测血清AFP和AFP-L3含量,计算AFP-L3%。结果肝细胞癌患者的AFP-L3%明显高于其他肝病患者(χ2=29.329,P<0.001);AFP、AFP-L3%检测肝细胞癌在ROC曲线下的面积AUC分别为0.407和0.841;以AFP-L3%≥12.6%作为诊断标准,AFP-L3诊断肝细胞癌敏感性和特异性分别为83.3%和86.3%。结论AFP-L3对肝细胞癌诊断准确度明显高于AFP,微量离心柱法检测AFP-L3在良恶性肝脏病变鉴别诊断中具有重要临床价值。

Objective To explore the clinical significance of Lens culinaris agglutinin-reactive alpha-fetoprotein in the differenti- ation diagnosis between benign and malignant liver diseases,as well as the warning of hepatocellular carcinoma.Methods Alpha-fetoprotein variants from 185 patients with liver diseases were isolated with micro-spin column equipped lens culinaris agglutinin （LCA） .The AFP and AFP-L3 were then detected by time-resolved fluorescence immunoassay,and the proportions of AFP-L3 （AFP-L3% ） were calculated.Results The AFP-L3% in patients with hepatocellular carcinoma（HCC） was significantly higher than that in patients with other liver diseases （χ^2 = 29. 329, P 〈 0. 001 ） ; the area under curve of Receiver-Operating Characteristic of AFP and AFP-L3% were 0.407 and 0.841 respectively,and according as AFP-L3% ≥ 12.6% being the diagnosis criteria,the sensitivity and specificity of patients diagnosed with liver cancer was 83.3 % and 86.3 % respectively. Conclusion The accuracy of AFP-L3 detection in the diagnosis of HCC was significantly higher than AFP detection. The detection of AFP-L3 by micro-spin column assay showed great clinical value in the differentiation diagnosis of HCC,especially for identifying HCC with low level of alpha-fetoprotein.