甲胎蛋白检测在HBV感染相关疾病中的临床意义

目的:探讨甲胎蛋白(AFP)检测在HBV感染相关疾病中的临床意义和作用。方法:检测慢性乙型肝炎(慢乙肝)合并肝癌(290人)、慢乙肝合并肝硬化(333人)、慢乙肝(361人)、无症状HBV携带(113人)及正常健康者(240人)血AFP水平,用Lo-gistic回归方法分析影响AFP升高的因素,用Spearmen等级相关方法分析AFP升高幅度与疾病严重程度的相关性。结果:五个观察组中,AFP>20ng/mL的阳性率分别为70.7%、44.4%、16.3%、2.7%和0%;AFP>200ng/mL阳性率分别为46.6%、9.3%、1.7%、0.9%和0%;AFP>400ng/mL阳性率分别为37.4%、4.8%、0.8%、0%和0%;AFP>1000ng/mL阳性率分别为26.6%、1.5%、0.6%、0%和0%。回归分析结果提示慢乙肝、饮酒量、饮酒年数、年龄及ALT和AST与AFP>20ng/mL相关;慢乙肝与AFP>200ng/mL相关;AST与AFP>400ng/mL相关;总胆红素及直接胆红素与AFP>1000ng/mL相关。等级相关分析结果发现AFP升高幅度与疾病的严重程度有相关性(r=0.533,P<0.01)。结论:AFP升高在不同HBV感染相关疾病组的临床意义有所不同;慢乙肝、饮酒、年龄及肝功能等因素可影响AFP的水平;AFP>400ng/mL高度提示肝癌的发生。

Clinical significance of alpha-fetoprotein detection in HBV infectious related diseases

AIM:To analyze the clinical significance of alpha-fetoprotein(AFP) detection in HBV infectious related diseases.METHODS:The AFP levels in the patients with hepatocellular carcinoma(290 cases),liver cirrhosis(333 cases),chronic hepatitis B(CHB)(361 cases),asymptomatic HBV infection(113 cases)and normal individuals(240 cases)were detected.The logistic regression assay was used to predict the dependent variables which were related to the elevation of AFP.RESULTS:The rates of AFP>20 ng/mL in the five groups were 70.7%,44.4%,16.3%,2.7% and 0%,respectively.The rates of AFP>200 ng/mL were 46.6%,9.3%,1.7%,0.9% and 0%,respectively.The rates of AFP>400 ng/mL were 37.4%,4.8%,0.8%,0% and 0%,respectively.The rates of AFP>1 000 ng/mL were 26.6%,1.5%,0.6%,0% and 0%,respectively.The results of multinomial logistic regression analysis predicted that the variables of age,alcohol drinking quantity and time,CHB,AST,ALT were related to the presence of AFP>20 ng/mL.CHB was related to the presence of AFP>200 ng/mL.AST was related to the presence of AFP>400 ng/mL,and total bilirubin and direct bilirubin were related to the presence of AFP>1 000 ng/mL.CONCLUSION:There are different clinical significance of the AFP levels in different HBV infectious related diseases.The level of AFP is influenced by the factors of age,alcohol drinking,CHB,AST,ALT and bilirubin.The level of AFP more than 400 ng/mL is a significant predictor for the development of hepatocellular carcinoma.