甲胎蛋白异质体在肝癌早期诊断和预警作用研究

Significance of Lens culinaris-reactive alpha-fetoproteins in early diagnosis and warning of hepatocellular carcinoma

目的:探讨甲胎蛋白异质体(AFP-L3)在肝癌的早期诊断价值和对高危人群的预警作用。方法:分别用微量离心柱法和电化学发光法检测176例治疗前原发性肝癌患者和251例慢性肝病患者血清中的AFP-L3和AFP。并对其中的62例慢性肝病患者跟踪随访两年,动态监测AFP-L3。结果:肝癌组的AFP-L3敏感性和中位水平分别为84.09%和16.85,高于良性肝病组(P<0.05)。20<AFP<200 ng/ml时AFP-L3的敏感性为74.36%,特异性为74.64%。AFP-L3的阳性率和水平与肝癌分期和肿瘤大小相关。随着肝癌分期的升高和肿瘤大小的增大而升高,Ⅰ期肝癌和小肝癌的敏感性分别为60.87%和66.67%。随访的23例AFP-L3持续阳性的慢性肝病患者的肝癌发生率为47.83%,进展时间平均3.15个月。结论:AFP-L3在肝癌的早期诊断和高危人群的预警具有重要的临床价值。

Objective ：To explore the clinical value of Lens culinaris -reactive a- Fetoprotein（ AFP -L3） detec- tion in early diagnosis and warning of hepatocellular carcinoma（ HCC ）. Methods： AFP - L3 was isolated by using microspincolumn coupled with lens culinaris agghtinin（LCA） in 251 patients with chronic liver disease and 176 pa- tients with HCC. AFP and AFP - L3 were detected with electro1 chemiluminescent immunoassay and microspincolumn method, the proportion of AFP - L3 levels were calculated. AFP - L3 were dynamic detected in two years in 62 pa- tients with chronic liver disease. Results： There were significant differences in the sensitivity and median level of AFP- L3 （84.09% , 16.85 ）between the patients of PHC and CLD, The sensitivity and level of AFP- L3 were rised as the increase of tumor stages and tumor size. Among the 23 patients with chronic liver disease whose AFP - L3 was sustained to be positive, the incidence rate of getting along with HCC was 45.45% within the mean time of 3.15 months. Conclusion ： There were significant clinical values in the early diagnosis and warning of HCC with the detec- tion of AFP - L3.