磷脂酰肌醇蛋白聚糖-3和甲胎蛋白联合检测对原发性肝癌的诊断价值

The diagnostic role of combination of glypican-3 and AFP in primary hepatic carcinoma

目的通过联合检测磷脂酰肌醇蛋白聚糖-3(GPC3)、甲胎蛋白(AFP)在原发性肝癌患者血清及组织中的表达情况,探讨对原发性肝癌的诊断价值。方法分别采用ELISA和免疫组织化学法检测57例肝癌、74例肝炎后肝硬化患者和47例正常血清和肝组织GPC3、AFP表达水平,根据不同临床病理指标进行分组比较。结果 (1)肝癌患者、肝炎后肝硬化及正常对照者血清中GPC3水平分别为(212.6±137.5)、(60.9±27.8)、(39.5±18.7)ng/ml;肝癌患者血清GPC3浓度显著高于正常及肝炎后肝硬化患者(t=4.503,P<0.05;t=6.045,P<0.05);血清GPC3、AFP联合检测原发性肝癌的敏感性和特异性为84.2%和95.7%,均显著高于任一单项检测(t=4.132,P<0.05;t=6.514,P<0.05);(2)GPC3在肝癌组织表达高于癌旁和正常肝组织(t=3.724,P<0.05;t=15.799,P<0.05);GPC3与肿瘤大小、肿瘤数目、HBsAg及AFP水平无明显相关,而与病理分级和临床分期有关;(3)AFP阳性肝癌血清GPC3阳性率为91.4%,而在AFP阴性肝癌中GPC3阳性率为59.1%。结论 GPC3联合AFP检测有助于提高原发性肝癌的确诊率,检测GPC3有助于提高AFP阴性患者肝癌的确诊率。

Objective To detect the expression of Glypican-3（GPC3） and α-fetoprotein（AFP） in serum and tissues of hepatic carcinoma patients.Methods ELISA and immunohistochemical staining were applied to detect GPC3 and AFP expressing level in the serum and tissues in 57 cases with primary hepatic carcinoma（PHC） and tumor-adjacent specimens were also detected,74 cases with post-hepatitis cirrhosis and 47 normal liver specimens.Correlation of combined expression of GPC3 and AFP and clinical pathology parameters was analyzed.Results The expression level of GPC3 in the serum of PHC and post-hepatitis cirrhosis patients and healthy people is（212.6±137.5）ng/ml,（60.9±27.8）ng/ml and（39.5±18.7）ng/ml respectively.GPC3 level in the serum of PHC was significantly higher than that of post-hepatitis cirrhosis and healthy people（t=4.503,P〈0.05;t=6.045,P〈0.05）.Sensitivity and specificity of combined detection of GPC3 and AFP was 84.2% and 95.7% respectively in PHC,which was significantly higher than that of any individual detection（t=4.132,P〈0.05;t=6.514,P〈0.05）.The expression level of GPC3 was significantly higher in PHC than tumor-adjacent tissue and normal liver tissue（t=3.724,P〈0.05;t=15.799,P〈0.05）.The expression of GPC3 was positively correlated with pathological grade and clinical stage,but not with tumor size,tumor number and the level of HBsAg or AFP in serum.The positive rate of GPC3 in serum of AFP-negative PHC was 59.1% while 91.4% in the AFP-positive PHC.Conclusion Detection Combined with GPC3 and AFP can improve the sensitivity and specificity of PHC,and detecting GPC3 may improve the diagnostic rate of AFP-negative PHC.