精氨酸酶-1和磷脂酰肌醇蛋白聚糖-3联合检测在肝细胞癌鉴别诊断中的应用

Application of arginase-1 and glypican-3 combined examination in differential diagnosis of hepatocellular carcinoma

目的 探讨精氨酸酶-1和磷脂酰肌醇蛋白聚糖3（GPC-3）联合检测在肝细胞癌与肝脏转移性癌、肝内胆管细胞癌（ICC）鉴别诊断中的应用价值。方法选取2005年1月至2011年12月肝细胞癌患者54例，其中高分化10例，中分化25例，低分化19例。另选取同期肝脏转移性癌患者25例，ICC患者20例。以3i份正常肝组织标本为对照。用免疫组织化学法检测上述肝组织中精氨酸酶-1和GPC-3的表达情况，分析其诊断肝细胞癌的敏感度和特异度。计数资料行卡方检验。结果精氨酸酶-1在肝细胞癌、肝脏转移性癌、ICC、正常肝组织中的阳性表达率分别为87．0％（47／54）、4．0％（1／25）、5．0％（1／20）、100．0％（31／31），其在肝细胞癌中的阳性表达率高于非肝细胞癌的肿瘤组织，差异有统计学意义（X^2==66．98，P〈0．05）。GPC-3在肝细胞癌、肝脏转移性癌、ICC、正常肝组织中的阳性表达率分别为70．4％（38／54）、12．0％（3／25）、5．0％（1／20）、0（0／31），其在肝细胞癌中的阳性表达率高于非肝细胞癌的肿瘤组织，差异有统计学意义（X^2=37．98，P〈0．05）。精氨酸酶-i或GPC-3中任意-项阳性即诊断肝细胞癌的敏感度和特异度分别为92．6％（50／54）和86．7％（39／45）。以精氨酸酶-1和GPC-3皆阳性诊断肝细胞癌的敏感度和特异度分别为64．8％（35／54）和100．0％（45／45）。结论 联合检测精氨酸酶-i和GPC-3在肝细胞癌诊断，以及肝细胞癌与ICC、肝脏转移性癌的鉴别诊断中具有重要价值。

Objective To explore the value of arginase-l（Arg-1） and glypican-3（GPC-3） combinedexamination in the differential diagnosis of hepatocellular carcinoma （HCC）, metastatic carcinoma （MC）of liver and intrahepatic cholangiocarcinoma （ICC）. Methods From January 2005 to December 2011,a total of 54 patients with HCC were selected, including 10 cases with high differentiation, 25 cases withmoderate differentiation and 19 cases with poor differentiation. At the same time, 25 patients with MC ofliver and 20 patients with ICC were selected. A total of 31 normal liver specimens were set as control. Theexpressions of Arg-1 and GPC-3 in the above tissues were detected by immunohistochemistry method. Thesensitivity and specificity of the examination in the diagnosis of HCC were analyzed. Chi-square test wasperformed for count data analysis. Results The positive expression rate of Arg-1 in HCC, MC of liver,ICC and normal liver tissues was 87.0% （47/54）, 4.0% （1/25）, 5.0% （1/20） and 100.0% （31/31）,respectively. The Arg-1 positive expression rate in HCC tissues was higher than that in other tumortissues of non-HCC, and the difference was statistically significant （）2= 66.98, P%0.05）. The positiveexpression rate of GPC-3 in HCC, MC of liver, ICC and normal liver tissues was 70.4% （38/54）, 12.0%（3/25）, 5.0%（1/20） and 0 （0/31）, respectively. The GPC-3 positive expression rate in HCC tissueswas higher than that in other tumor tissues of non-HCC and the difference was statistically significant （2 =37.98, P〈0.05）. The sensitivity and specificity of Arg-1 or GPC-3 positive in HCC diagnosis was 92.6G （50/54） and 86.7% （39/45）. The sensitivity and specificity of both Arg-1 and GPC 3 positive in HCC diagnosis was 64. 8% （35/54） and 100. 0% （45/45）. Conclusion Arginase-1 and glypican-3 combined examination has an important value in HCC diagnosis and differential diagnosis.