肝癌介入治疗前后原癌基因Pokemon、甲胎蛋白异质体、甲胎蛋白、脱γ-羧基凝血酶原联合检测的临床价值

Clinical value of combined detection of pokemon,AFP-L3,AFP and DCP after transarterial chemoembolization for hepatocellular carcinoma

目的研究原癌基因Pokemon、甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、脱γ-羧基凝血酶原(DCP)在原发性肝癌(HCC)病人介入治疗前后表达量变化及其与治疗效果之间的关系。方法纳入30例HCC病人,均行肝动脉化疗栓塞(TACE),酶联免疫吸附试验(ELISA)检测治疗前后血清中Pokemon、AFP、AFP-L3、DCP的表达量,分析四者TACE前后表达量变化与治疗效果之间的关系,并对TACE治疗后复发者与未复发者Pokemon、AFP、AFP-L3、DCP的表达量变化进行探讨。结果(1)TACE治疗有效组Pokemon、AFP、AFP-L3、DCP的表达量分别为(50.09±4.91)μg·L^(-1)、(322.67±64.53)μg·L^(-1)、(10.26±1.08)μg·L^(-1)、(42.66±9.43)AU·L^(-1),低于治疗前Pokemon、AFP、AFP-L3、DCP的表达量(103.10±7.65)μg·L^(-1)、(807.36±113.55)μg·L^(-1)、(27.42±3.00)μg·L^(-1)、(93.39±4.70)AU·L^(-1);t=6.741、7.740、7.534、4.985;P=0.000、0.000、0.000、0.001。治疗无效组Pokemon、AFP、AFP-L3、DCP的表达量分别为(87.71±5.73)μg·L^(-1)、(503.20±132.01)μg·L^(-1)、(20.31±2.66)μg·L^(-1)、(73.11±8.36)AU·L^(-1),与治疗前四者的表达量相比(93.47±1.92)μg·L^(-1)、(610.55±101.69)μg·L^(-1)、(21.18±1.97)μg·L^(-1)、(75.01±7.29)AU·L^(-1),差异无统计学意义(t=1.801、1.280、0.626、0.764;P=0.146、0.270、0.565、0.488)。(2)按治疗后3个月是否复发将有效组分为复发者和未复发者,复发者Pokemon、AFP、AFP-L3、DCP的表达量分别为(114.63±16.28)μg·L^(-1)、(763.50±140.22)μg·L^(-1)、(18.58±2.09)μg·L^(-1)、(87.93±8.57)AU·L^(-1),与TACE治疗后1个月(复发前)Pokemon、AFP、AFP-L3、DCP的表达量[(65.90±8.25)μg·L^(-1)、(400.60±99.11)μg·L^(-1)、(9.17±1.27)μg·L^(-1)、(35.93±4.10)AU·L^(-1)]相比,差异有统计学意义(t=2.598、6.247、5.762、6.122;P=0.029、0.000、0.000、0.000)。结论 TACE治疗有效者Pokemon、AFP、AFP-L3、DCP的表达量明显下降,复发者四种标志物的表达量再次升高,提示四者对监测HCC的治疗效果及预测肿瘤的复发有一定的参考价值,但需进一步研究证实。

Objective To explore the correlation between changes of expression levels of Pokemon,AFP,AFP-L3 or DCP after transarterial chemoembolization for hepatocellular carcinoma(HCC) and treatment effectiveness. Methods In this study,the serum levels of Pokemon,AFP,AFP-L3 or DCP in 30 patients with HCC were examined by enzyme-linked immunosorbent assay before and after transarterial chemoembolization. Then the relation between treatment effectiveness and the changes of serum expression levels of Pokemon,AFP,AFP-L3 or DCP was analysed. And the changes of expression levels of Pokemon,AFP,AFP-L3 or DCP in patients with neoplasm recurrence or non-recurrence after transarterial chemoembolization were assessed. Results The serum expression levels of Pokemon,AFP,AFP-L3 or DCP in therapeutic-response group were(50. 09 ± 4. 91) μg · L^(-1),(322. 67 ± 64. 53) μg·L^(-1),(10. 26 ±1. 08) μg·L^(-1),(42. 66 ± 9. 43) AU·L^(-1),apparently lower than those before therapy(103. 10 ± 7. 65) μg·L^(-1),(807. 36 ± 113. 55)μg·L^(-1),(27. 42 ± 3. 00) μg·L^(-1),(93. 39 ± 4. 70) AU·L^(-1)(t = 6. 741,7. 740,7. 534,4. 985; P = 0. 000,0. 000,0. 000,0. 001).The serum expression levels of Pokemon,AFP,AFP-L3 or DCP in therapeutic-nonresponse group were(87. 71 ± 5. 73) μg · L^(-1),(503. 20 ± 132. 01) μg·L^(-1),(20. 31 ± 2. 66) μg·L^(-1),(73. 11 ± 8. 36) AU·L^(-1),which showed no statistically significant difference from those before therapy(93. 47 ± 1. 92) μg·L^(-1),(610. 55 ± 101. 69) μg·L^(-1),(21. 18 ± 1. 97) μg·L^(-1),(75. 01 ± 7. 29) AU·L^(-1)(t = 1. 801,1. 280,0. 626,0. 764; P = 0. 146,0. 270,0. 565,0. 488). Therapeutic-response group was further assigned into recurrence and non-recurrence groups according to whether there was neoplasm recurrence or not 3 months after treatment. The serum expression levels of Pokemon,AFP,AFP-L3 or DCP in neoplasm recurrence group were(114. 63 ± 16. 28) μg·L^(-1),(763. 50 ± 140. 22) μg·L^(-1),(18. 58 ± 2. 09) μg·L^(-1),(87. 93 ± 8. 57) AU·L^(-1),which showed statistically significant differences from those 1 month after treatment(65. 90 ± 8. 25) μg·L^(-1),(400. 60 ± 99. 11) μg·L^(-1),(9. 17 ± 1. 27) μg·L^(-1),(35. 93 ± 4. 10) AU·L^(-1)(t = 2. 598,6. 247,5. 762,6. 122; P = 0. 029,0. 000,0. 000,0. 000). Conclusions The expression levels of Pokemon,AFP,AFP-L3 or DCP after transarterial chemoembolization for HCC were significantly decreased,while the expression levels of four markers rise again in neoplasm recurrence,which suggests that the four markers have certain value in assessing treatment effectiveness and monitoring tumor recurrence,but it needs to be further studied.