AFP-IgM复合物在肝癌中的表达与临床关系

Expression of AFP-IgM immune complexes in hepatocellular carcinoma and its clinical significance

目的 分析甲胎蛋白-IgM免疫复合物（AFP—IgM）在肝细胞癌（HCC）中的含量，探讨AFP-IgM对诊断肝癌的临床意义。方法采用酶联免疫吸附法与电化学发光法，对103名正常人、74例肝癌、43例肝硬化和58例脂肪肝病人血清AFP—IgM与甲胎蛋白（AFP）含量检测，并分析其与临床病理特点之间的关系。结果应用ROC曲线确定AFP-kM和AFP的最佳切割值分别为300Au／ml和10μg／L作为诊断学意义的临界值。在此切割值下，肝癌组AFP-IgM和AFP血清水平均高于脂肪肝组和健康体检组（P〈0．05）。对早期（Ⅰ与Ⅱ期）肝癌诊断时，AFP-IgM的ROC曲线下面积大于AFP（0．91vs0．82）；当肿瘤直径≤3cm时，AFP-IgM为（1090．4±571．8）Au／ml，而当直径〉3cm时，AFP-IgM为（604．9±749．9）Au／ml，两者比较P〈0．05。且AFP-IgM在诊断小肝癌时ROC曲线下面积大于AFP（0．92VS0．78）；AFP-IgM对性别、年龄、乙型肝炎表面抗原、肿瘤数量、包膜的相关性无统计学意义（P〉0．05），而与肿块大小和分期密切相关。结论AFP-IgM对早期（Ⅰ与Ⅱ期）肝癌和小肝癌（≤3cm）诊断具有重要作用，且对判断肝癌的肿瘤大小与分期等具有一定的临床意义。

Objective To determine the contents of the new tumor marker alpha fetoprotein immunoglobulin M immunoeomplex （AFP-IgM） in hepatocellular carcinoma （HCC） and evaluate the correlation between the level of AFP-IgM and clinical feature of HCC. Methods The contents of AFP-IgM and AFP in serum of 103 healthy subjects, 74 patients with HCC, 43 patients with hepatic cirrhosis and 58 patients with adiposis hepatica were detected by enzyme linked immunosorbent assay and electrochemiluminescence. Results As the critical value of diagnostic significance, the best cutoff value of AFP-IgM and AFP was 300 Au/ml and 10 ug/L, respectively. Under the cutoff value, the mean serum concentrations of AFP-IgM and AFP were significantly higher in the HCC group than in the adiposis hepatica and health examination groups （P〈0.05）. However, for early diagnosis of liver cancer （stage Ⅰ and Ⅱ ）, the area under ROC curve of AFP-IgM was larger than that of AFP （0.91 vs 0. 82）. The differences of AFP-IgM and AFP for early diagnosis of liver cancer were statistically significant. When the tumor was less than and over 3cm in diameter, the contents of AFP-IgM was （1090.4±571.8） Au/ml, and （604.9±749.9） Au/ml, respectilvely （P〈 0.05）. Furthermore, the area under ROC curve of AFP-IgM was larger than that of AFP （0.92 vs 0. 78） in diagnosis of small hepatocellular carcinoma. The dependability between the level of AFP-IgM and sex, age, HBsAg, the quantity of the tumor and capsule was not significant （P〉0.05）, but the level of AFP-IgM was closely correlated to the tumor size and stages. Conclusion AFP-IgM is of great significance for early diagnosis of liver cancer. Meanwhile, AFP-IgM has an effect in clinical judgment of the tumor size, differentiation and so on in liver cancer.