AFP、CEA、GPC3单独及联合检测在原发性肝癌诊断中的应用

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

目的:探讨3种血清肿瘤标志物甲胎蛋白(AFP)、癌胚抗原(CEA)、磷脂酰肌醇蛋白聚糖3(GPC3)单独及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:对我院2009年8月-2011年7月收治的55例PHC,30例肝硬化患者进行单独及联合检测AFP、CEA、GPC3,并选择同期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CEA水平,ELISA法检测GPC3水平。结果:PHC组血清AFP、CEA和GPC3水平均明显高于肝硬化组及正常对照组,差异有统计学意义(P<0.05)。PHC组患者血清AFP、CEA和GPC3阳性率分别为74.5%、69.1%和78.2%。血清指标AFP联合CEA或者GPC3可使检出率分别提高至81.8%和92.7%。三项指标联合检测PHC的阳性率可高达96.3%。AFP阴性的39例PHC患者中,血清GPC3、CEA阳性率分别为76.9%(30/39)、71.8%(28/39),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、CEA、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）,carcino-embryonic antigen（CEA） and glypican 3 to the diagnosis of primary hepatic carcinoma（PHC）.Methods：AFP,CEA and GPC3 in serum were measured in 55 cases of primary hepatic carcinoma,30 liver cirrhosis patients and 30 cases of healthy controls in our hospital from 2009 to 2011.The three indices were compared and analyzed for the complementary diagnostic values to primary hepatic carcinoma.By electrical spectrophotometer method to detect AFP,speed method to detect CEA and enzyme-linked immunosorbent assay method to detect GPC3.Results：AFP,CEA and GPC3 in PHC group were significantly higher than the other two groups（P〈0.05）.The positive detection rates of GPC3,AFP and CEA in PHC group were 78.2%,74.5% and 69.1% respectively.Simultaneous determination of AFP and CEA or glypican 3 could increase the sensitivities to 83.2% or 92.7% respectively.Furthermore,combined detection of these three indices could make the diagnostic sensitivities as high as 96.3%.In 39 cases with AFP-negative PHC,the positive detection rates of GPC3 and CEA were 76.9% and 71.8% respectively and manifested its complementary function.Conclusion：There is diagnostic value of AFP,CEA,GPC3 on PHC.The combined examination of AFP and GPC3 is superior,especially in those with negative or low serum level of AFP.