婴儿畸胎瘤甲胎蛋白量化检测的临床意义探讨

目的：探讨婴儿期畸胎瘤血清甲胎蛋白（alpha-fetoprotein，AFP）定量检测值与同月龄儿正常参考值上限的比值对成熟型、未成熟型及恶性畸胎瘤的辅助鉴别意义。方法回顾性分析1991年10月至2010年5月我们收治的166例畸胎瘤患儿临床资料。化学发光法定量检测血清AFP含量，将患儿检测值与正常同月龄儿参考值上限的比值作为血清AFP比值，结合成熟型、未成熟型及恶性畸胎瘤的病理诊断，分析血清AFP比值在鉴别3种不同类型畸胎瘤中的规律及其临床意义。结果①131例成熟型畸胎瘤血清AFP比值最大16.34（绝对值670 ng/mL）；13例未成熟型畸胎瘤血清AFP比值差异明显，7例Ⅰ级未成熟型畸胎瘤，最小AFP比值1.25，最大39.27；5例Ⅱ级未成熟型畸胎瘤，最小AFP比值1.23，最大139.51，其中2例比值大于83.17；1例Ⅲ级未成熟型畸胎瘤，AFP超出检测值上限；22例恶性畸胎瘤最小AFP比值83.17（绝对值499 ng/mL），13例超出检测上限；②未成熟型畸胎瘤血清AFP阳性率（12例，92.31％）和恶性畸胎瘤血清AFP阳性率（22例，100％）均高于成熟型畸胎瘤（58例，44.28％）（P＜0.05），未成熟型畸胎瘤与恶性畸胎瘤血清AFP阳性率无明显差异（P＞0.05）；＜9月龄婴儿血清AFP阳性率（33例，84.62％）高于9月龄婴儿（59例，46.46％）（P＜0.05）；性腺内畸胎瘤血清AFP阳性率（20例，76.92％）高于性腺外（72例，51.43％）（P＜0.05）。结论婴儿期畸胎瘤AFP阳性率受年龄、发病部位及肿瘤病理类型等因素的影响。血清AFP比值在不同类型畸胎瘤有相应变化规律，可用于术前辅助判断畸胎瘤良恶性及制定手术方案，对动态随访治疗效果有重要意义，结合病理检查对于术后是否化疗有决定作用。

Retrospective study of the diagnostic value of quantitative alpha-fetoprotein in infants with terato-mas

Objetive To explored the differential diagnostic value of quantitative Serum alpha-fetopro-tein （AFP）in infants compared with the upper limit of normal reference values in mature,immature and malig-nant teratomas. Methods The clinical data of 1 66 infants with teratomas underwent in this institute from Oc-tober 1 991 to May 201 0 were retrospectively analyzed. The value of serum AFP was defined as the ratios of chemiluminescent immunoassay measurement of AFP compared with upper limit of normal reference values.Analyze different value of serum AFP change rules in differential diagnostic the mature,immature and malig-nant teratomas with relation to the pathological diagnosis. Results ①The maximum value of serum AFP was 1 6.34（absolute value 670 ng/mL）in 1 31 cases of mature teratomas. The serum AFP value was significant difference in immature teratomas. The minimum serum AFP value was 1.25 and the maximum was 39.27 in 7 of 1 3 immature teratomas grade Ⅰ,while the minimum AFP value was 1.23 and the maximum was 1 39.51 in 5 of 1 3 immature teratomas gradeⅡ,2 of 1 3 were more than 83.1 7. Whose AFP value was higher than the up-per limit of the detection ranges was gradeⅢin 1 of 1 3 immature teratomas. The minimum serum AFP value in 22 was 83.1 7（absolute value 499 ng/mL）and higher than the upper limit of the detection ranges in 1 3 of 22 malignant teratomas;②The positive rate of serum AFP in immature teratomas（1 2,92.31%）and malignant teratomas（22,1 00%）was significantly higher than mature teratomas（58,44.28%）（P＆lt;0.05）. However,no statistical difference were found between immature teratomas and malignant teratomas（P＆gt;0.05 ）. Compared to the less than 9-month-old infants（33,84.62%）,the positive rate of serum AFP was higher than the older than 9 months of age （59,46.46%）（P ＆lt;0.05 ）.The positive rate of serum AFP in gonadal teratomas （20, 76.92%）higher than extragonadal teratoma（72,51.43%）（P＆lt;0.05）. Conclusion The positive rate of AFP was affected by age,tumor localization,histopathologic and other factors. The value of serum AFP differs in different histopathologic teratomas. Our results indicated that the variation rules of serum AFP value have im-portant significance in helping preoperative diagnosis teratomas of benign and malignant,and as a preoperative surgical guidance.