肝癌和肝病患者血清甲胎蛋白异质体的检测及临床意义

目的探讨甲胎蛋白异质体（AFP-L3）检测在肝癌鉴别诊断中的意义。方法应用微量离心柱法分离检测小扁豆凝集素结合型AFP-L3的含量,同时检测血清中AFP总含量,由此得出AFP-L3的百分含量（AFP-L3%）。结果以AFP-L3%〉10%作为阳性判断标准,27例肝癌患者血清AFP-L3阳性率为70%,肝硬化和慢性肝炎AFP-L3%分别为10%和9.6%,肝癌AFP-L3%水平明显高于肝硬化和慢性肝炎（P〈0.01）;以AFP〉25ng/ml作为阳性判断标准,肝癌、肝硬化和慢性肝炎患者血清中AFP阳性率分别为78%、60%和55%;以AFP、AFP-L3%作为诊断肝癌指标的灵敏度分别是78%、70%,特异度分别是43%、90%。结论 AFP-L3%能有效区分肝癌和慢性肝病,弥补肝癌诊断的不足,具有一定的临床实用价值。

The Significance of Measurement of AFP-L3 Variant in Patients with hepatocellular carcinoma and liver diseas

Objective To evaluate the clinical significance of serum AFP heterogeneity（AFP-L3） assay in patients with hepatocellular carcinoma. Methods Lentil lectin-binding serum AFP-L3 variants were separated by microcentrifu- gal column,and the content percentage of AFP-L3（AFP-L3%） variants and total serum AFP was detected by chemilu- minescence analysi. Results When AFP-L3〉10% was used as a positive criterion,there was a positive rate of 70% in 27 cases of hepatocellular carcinoma（HCC）,which in cirrhosis and chronic hepatitis were 10% and 9. 6%respective ly. AFP-L3% levels were the highest in hepatocellular carcinoma than those in cirrhosis and chronic hepatitis （P〈0.01）. While AFP〉 25 μg/L was used as a positive criterion, the AFP positive rates were 78%, 60% and 55 %, in HCC,cirrhosis and chronic hepatitis respectively. The sensitivity of AFP and AFP-L3 was 78% ,70% ,the speciality of AFP ang AFP-L3 was 43 % , 90 %,in HCC respectively. Conclusion AFP L3 is very useful in the differential diagnosis of hepatocellular carcinoma.