血清首氨酰脯氨酸二肽氨基肽酶同工酶对原发性肝癌的诊断价值

目的研究血清甘氨酰脯氨酸二肽氨基肽酶（ｇｌｙｃｙｌｐｒｏｌｉｎｅ　ｄｉｐｅｐｔｉｄｙｌ　ａｍｉｎｏｐｅｐｔｉｄａｓｅ，ＧＰＤＡ）同工酶对ＰＨＣ的诊断价值，提高早期 ＰＨＣ和 ＡＦＰ阴性ＰＨＣ诊断水平。方法采用阶段梯度垂直平板聚丙烯酰胺凝胶电泳法进行血清ＧＰＤＡ同工酶分离检测，同步测定比较ＰＨＣ患者血清ＧＰＤＡ同工酶与ＧＰＤＡ，Ｑ．活性（ＴＧＰＤ）、ＡＦＰ、肿瘤大小及ＡＬＴ的关系。结果血清ＧＰＤＡ按其泳动速度可分为快带（ＧＰＤＡ－Ｆ）与慢带（ＧＰＤＡ－Ｓ）两种同工酶。ＰＨＣ患者血清ＧＰＤＡ－Ｆ的阳性率为８５．３％，而肝外肿瘤、转移性肝癌、肝炎后肝硬化、慢性肝炎中阳性率均较低，正常对照组以及良性肝占位全部阴性。ＧＰＤＡ－Ｆ阳性率在ＴＧＰＤＡ活性增高组明显高于正常组（９４．４％对７５０％），ＧＰＤＡ－Ｆ与ＡＦＰ及肿瘤大小无关系。良性肝病ＡＬＴ升高组ＧＰＤＡ－Ｆ阳性率高于ＡＬＴ正常组，而ＰＨＣ患者ＧＰＤＡ－Ｆ与ＡＬＴ无关。ＰＨＣ患者ＧＰＤＡ－Ｆ呈持续阳性，良性肝病患者ＧＰＤＡ－Ｆ常为一过性阳性。结论ＧＰＤＡ－Ｆ为一新的ＰＨＣ血清标志物，有助于ＰＨＣ的定性诊断，尤其对早期ＰＨＣ及ＡＦＰ阴性ＰＨＣ的诊断具有重要价值。

The value of serum GPDA-F for the diagnosis of primary hepatocellular carcinoma

Objective To investigate the role of glycylproline dipeptidyl aminopeptidase isoenzymes in the diag- nosis of primary hepatocellular carcinoma (PHC). Methods We developed a stage gradient polyacrylamide gel electro- phoresis system to separate serum GPDA isoenzymes. Total GPDA activities, alpha-fetoprotein, the sizes of tumors and alanine aminotransferase (ALT) activities were also measured simultaneously and the correlation between GPDA-F and these indices was analyzed. Results Serum GPDA was separated into two bands, namely fast band (GPDA-F) and slow band (GPDA-S). GPDA-F was negative in all healthy persons as well as in the patients with benign liver filling defects, while it was positive in 85.3% cases of PHC. Liver cirrhosis, chronic hepatitis, extrahepatic carcinoma and metastatic liver carci- noma had low positive rates. GPDA-F was positively correlated with serum total GPDA activities, but had no correlation with AFP and size of the tumors. There was the correlation between GPDA-F and ALT in benign liver diseases, but no correlation between GPDA-F and ALT in PHC. Serial measurements of serum GPDA-F showed that GPDA-F was persistently positive in PHC but might change into negative in benign liver diseases. Dynamic determination of GPDA-F might be helpful to differentiate true positive of PHC from false positive of benign liver diseases. Conclusion GPDA-F is a new serum marker of PHC. Measurement of serum GPDA-F is of value for the diagnosis of PHC, especially for those at early stage or with negative AFP.