腹腔积液甲胎蛋白异质体检测在肝癌及疗效观察中的应用价值

Value of the detection of alpha-fetoprotein variants of ascites in identification,warning and curative effect observation of HCC

目的探讨腹腔积液甲胎蛋白异质体(AFP-L3)检测在肝源性腹腔积液良恶性鉴别、肝细胞癌(HCC)预警及疗效观察中的应用价值。方法应用AFP-L3亲和吸附离心管法,分离130例次肝源性腹腔积液患者腹腔积液及同时段血清中的AFP-L3,用微粒子化学发光免疫法检测腹腔积液及血清AFP和AFP-L3的含量,计算同一标本的AFP-L3/AFP比值,记为AFP-L3%。结果 48例次肝细胞癌患者腹腔积液及血清中AFP-L3%明显高于其他肝病患者。若以AFP-L3%≥10%为肝癌阳性诊断指标,HCC患者腹腔积液及血清中AFP-L3%阳性诊断率明显高于其他肝病患者,HCC患者腹腔积液及血清阳性诊断率分别为81.25%、68.75%。其他肝病患者阳性诊断率分别为14.63%、13.41%。同组间比较HCC患者的腹腔积液和血清阳性诊断率差异有统计学意义(P<0.05);其他肝病患者腹腔积液和血清阳性诊断率,差异无统计学意义(P>0.05)。腹腔积液和血清AFP-L3%诊断HCC的敏感度分别为82.69%和71.15%;特异性分别为89.74%和91.31%;准确度分别为86.92%和83.85%。肝细胞癌患者治疗前后腹腔积液AFP-L3%阳性诊断率分别为85.71%、76.00%;血清AFP-L3%阳性诊断率分别为78.57%、64.00%,治疗前后差异有统计学意义(P<0.01)。初步诊断非肝细胞癌患者44例,其中25例不同时段动态检测腹腔积液及血清AFP-L3%,4例两次以上阳性者,最后确诊为HCC。结论腹腔积液AFP-L3检测在肝源性腹腔积液良恶性鉴别上较血清AFP-L3检测灵敏度更高,特异性、准确度差别不大,对肝细胞癌患者诊断及疗效观察具有一定意义。

Objective To explore the application of alpha fetoprotein variants（AFP-L3） of benign and malig nant ascites in identification, warning and curative effect observation of hepatocellular carcinoma （HCC）. Methods Ascites and serum AFP-L3 were separated by centrifugal column method in 130 patients with Liver-de- rived ascites,and the aseites and serum levels of AFP and AFPL3 were detected by microparticle chemiluminescent immunoassay method. It calculated the ratio of AFP L3/AFP in the same sample, that signed AFP L3 （~）. Results The ascites and serum levels of AFP-L3M in 48 patients with HCC group was significantly higher than these in other liver diseases. AFP-L3 （~） ~ 10 ng/mL were taken as the diagnostic criterion, the levels of AFP L3 （~/00） in patients with HCC were significantly higher than those in the patients with other liver diseases. The positive diagnostic rates of AFP-L3 in HCC patients ascites and serum were 81.25% and 68.75% respectively（P〈0.01）, these in other liver diseases patients were 14.63% and 13.41%（P〈0.05）. The sensitivities of AFP-L3 in HCC pa- tients ascites and serum were 82.69% and 71.15 %, and the specificities of them were 89.74 % and 91.31%, the de- grees of accuracy were 86.92% and 83.85%. The positive diagnostic rates of AFP-La between pre and post treat- ment were 85.71% and 76.00% in HCC patients ascites（P〈0.01） ,and these in serum were 78.57% and 64.00% （P〈0.01）. Conclusion The levels of AFP L3 in ascites can be used in differential diagnosis of benign and malignant ascites,and ascites AFP-L3 is more sensitive in differential diagnosis of benign and malignant Liver than that in the serum. The specificity and the degree of accuracy have no significant difference. The ascites level of AFP-L3 has cer tain significance in HCC observation of curative effect,and it has important value in the early warning of HCC.