检测肝癌患者外周血癌细胞表达AFP mRNA的临床意义

The detection of α-fetoprotein mRNA in peripheral blood of patients with hepatic carcinoma and its clinical significance

目的 探讨肝癌患者外周血癌细胞表达AFPmRNA的临床意义。方法 采用NestedRT PCR检测外周血中癌细胞表达的AFPmRNA。结果 原发性肝癌患者 45例 ,AFPmRNA阳性率76 % (34 / 45 )。 17例继发性肝癌患者 ,原发癌来自结肠癌 7例、直肠癌 5例、胆囊癌 2例 ,小肠平滑肌肉瘤 2例、乳腺癌 1例。AFPmRNA阳性率 6 5 % (11/ 17)。原发性肝癌患者AFPmRNA阳性率在AFP大于 2 0 μg/L组 90 % (2 6 / 2 9)、有肝外转移组 94% (16 / 17)、TNM分期Ⅳ期组 88% (2 3/ 2 6 )分别高于AFP小于 2 0 μg/L组 5 0 % (8/ 16 )、未发现肝外转移组 6 4% (18/ 2 8)和TNM分期Ⅱ期组 46 % (6 / 13) (P <0 0 5 ,P <0 0 1)。继发性肝癌患者AFPmRNA阳性率在肝外肿瘤存在组 90 % (9/ 10 )较肝外无肿瘤组(原发病灶切除 ) 2 8 6 % (2 / 7)为高 (P =0 0 36 )。结论 检测肝癌患者外周血中有核细胞表达AFPmRNA较血清AFP更敏感 ,可作为肝癌的诊断、恶性肿瘤分期和有无肝外转移及愈后的指标。

Objective[WT5”BZ] To investigate the clinical significance of the expression of alpha fetoprotein mRNA (AFPmRNA) in peripheral blood of the patients with hepatocellular carcinoma (HCC).[WT5”HZ] Methods[WT5”BZ] AFPmRNA was detected in peripheral blood of HCC patients by nested RT PCR.[WT5”HZ]Results[WT5”BZ] AFPmRNA was detected in 34 out of 45 (76%) HCC patients and in 11 out of 17 (65%) patients with secondary hepatic cancer (SHC).AFPmRNA was detected in 90% (26/29) in HCC patients with serum AFP>20 μg/L, in 94 1%(16/17) of those with metastasis, and in 88%(23/26) of stage Ⅳ HCC patients, compared with HCC patients with serum AFP<20 μg/L 50%(8/16), those without metastasis 64% (18/28) and stage Ⅱ HCC patients 46% (6/13) ( P <0 05, P <0 01).The detection rate of AFPmRNA in SHC patients in whom the extrahepatic tumors were not resected was 90% (9/10) compared with 29% (2/7) in whom the extrahepatic tumors were resected ( P =0 036).[WT5”HZ]Conclusion[WT5”BZ] The expression of AFPmRNA in the peripheral blood is more sensitive than serum AFP detection as a tumor marker in HCC patients.It may be of clinical significance for the diagnosis,staging, detection of extrahepatic metastasis and prognosis of HCC patients.