甲胎蛋白糖类抗原磷脂酰肌醇蛋白聚糖3单独或联合检测在原发性肝癌诊断中的研究

A study on the separately or combined detection of AFP CA199 and GPC3 in the diagnosis of primary hepatic cancer

目的探讨甲胎蛋白(AFP)、糖类抗原(CA199)、磷脂酰肌醇蛋白聚糖3(GPC3)三种血清肿瘤标志物单独和(或)联合检测对原发性肝癌(PHC)的互补诊断价值及对肝癌早期诊断的意义。方法对2009年8月至2011年7月收治的55例PHC患者(PHC组)和30例肝硬化患者(肝硬化组)进行单独和(或)联合检测AFP、GPC3和AFU,并同期选择30例正常人作为对照组。采用电化学发光法测定AFP水平,速率法检测CA199水平,采用酶联免疫吸附试验(ELISA)法检测GPC3水平。结果 PHC组患者血清GPC3、CA199和AFP水平均明显高于肝硬化组和正常对照组,差异有统计学意义(P<0.05)。PHC组患者血清GPC3、AFP和CA199阳性率分别为81.8%、74.5%和67.3%,AFP联合CA199和(或)GPC3可使检出率分别提高至78.2%和92.7%,三项指标联合检测PHC的阳性率可高达98.2%。AFP阴性的39例PHC患者中,血清GPC3、CA199阳性率分别为76.9%(30/39)、74.4%(29/39),表明二者对AFP阴性的PHC患者具有较高的诊断互补作用。结论血清肿瘤标志物AFP、CA199和GPC3对PHC有一定的诊断价值。血清GPC3和AFP联合检测可明显提高PHC的诊断率,优于单项检测,特别是对AFP阴性或AFP呈低浓度PHC更具有诊断价值。

Objective To study the complementary value of alpha-fetoprotein（AFP）,Carbohydrate antigen199（CA199） and glypican3 in diagnosis of primary hepatic carcinoma（PHC）.Methods AFP,CA199 and GPC3 in serum were measured in 55 cases of primary hepatic carcinoma and 30 liver cirrhosis patients and 30 cases of healthy controls in our hospital from August 2009 to July 2011.The three indices were compared and analyzed for the complementary diagnostic values to primary hepatic carcinoma.Use electrical spectrophotometer method to detect AFP,speed method to detect CA199 and enzyme-linked immunosorbent assay method to detect GPC3.Results AFP,CA199 and GPC3 in PHC group were significantly higher than the other two groups（P0.05）.The positive detection rate of GPC3,AFP and CA199 in PHC group was 81.8%,74.5% and 67.3% respectively.Simultaneous determination of AFP and CA199 or glypican 3 could increase the sensitivities to 78.2% or 92.7% respectively.Furthermore,combines detection of these three indices could make the diagnostic sensitivities as high as 98.2%.In 39 cases with AFP-negative PHC,the positive detection rate of GPC3 and CA199 was 76.9% and 74.4% respectively and manifested its complementary function.Conclusion There was diagnostic value of AFP,CA199,GPC3 on PHC.The combining of examination in AFP and GPC3 is superior,especially in those with negative or low serum level of AFP.