热休克蛋白90联合甲胎蛋白在肝细胞癌早期诊断中的价值

背景肝细胞癌是全球第六大常见癌症,早期诊断主要依靠血清学检查,随着热休克蛋白90(heat shock protein 90,HSP90)对于肝细胞癌分子研究的深入,本研究创新性采用HSP90联合甲胎蛋白(alpha fetoprotein, AFP)的方法,探究联合诊断对于肝细胞癌的诊断价值.目的评估H S P 9 0联合甲胎蛋白A F P在肝细胞癌(hepatocellular carcinoma, HCC)的诊断价值.方法选取2017-08/2020-07原发性肝癌、病毒性肝炎后肝硬化(乙型、丙型)、健康体检者共383位,采用电化学法检测AFP血清浓度, ELLISA法检测HSP90血清浓度,并使用统计学软件对结果进行处理及分析.结果单独分析AFP及HSP90对HCC的诊断价值,敏感度HSP90AFP,特异度AFPHSP90, AFP联合HSP90的灵敏度和特异度达到87.8%和91.2%.结论AFP联合HSP90建立新型HCC诊断模型能显著提高HCC诊断价值.     

Hep Par 1、CD34及Cytokeratin在血清AFP阴性肝细胞癌诊断中的应用

目的:探讨Hep Par 1、CD34及Cytokeratin在血清[AFP(-)HCC]诊断及其在ICC、MAC鉴别诊断中的意义.方法:选取南通市肿瘤医院1989-2007年手术切除的70例[AFP(-)HCC]、6例ICC及24例MAC的石蜡标本,免疫组织化学染色法检测Hep Par 1、CD34及Cytokeratin在血清[AFP(-)HCC]中的表达.结果:Hep Par 1、CD34在血清AFP(-)HCC、ICC及MAC中的表达差异性均具有显著统计学意义(Hep Par 1:χ2=50.7937、9.5745及37.4532;CD34:χ2=67.0330、9.9836)及49.3927,均P<0.01).在分化不良组与分化较好组血清AFP(-)HCC中表达差异性的比较中,Hep Par 1与CD34、CK20、CK19的表达均有统计学意义(P<0.01或0.05).联合应用Hep Par1、CD34对AFP(-)HCC与ICC、MAC的鉴别诊断评价准确度、灵敏度及特异度分别为:90.7%、89.8%及93.3%.结论:联合应用Hep Par 1、CD34及Cytokeratin可提高血清AFP(-)HCC的诊断准确率及其与ICC、MAC的鉴别诊断准确率,为临床治疗方案的选择与预测评估提供了病理依据.     

甲胎蛋白异质体、唾液酸和5′-NPD检测的临床意义

本文通过对47例原发性肝癌(PHC)、40例良性肝病和6例转移性肝癌及正常对照30例同时检测血清甲胎蛋白(AFP)异质体,唾液酸(SA)和5′-NPD(5′-核苷酸磷酸二酯酶同功酶),并与血清AFP 值对照.结果,在PHC 中,AFP 异质体为43.3±22.4%,SA 为2.96±0.7nvnol/L,5′-NPD-V 和Ⅵ带的相对面积分别为2.37±2.82%和2.73±3.2%;而在良性肝病中分别为10.35±17.05%,1.92±0.57nvnol/L,0.40±0.71%和0.36±0.48%(P<0.01).AFP 异质体、SA 和5′-NPD 对PHC 诊断的敏感性分别为82.98%、78.72%和87.23%,特异性分别为90%、82.5%和75%;对AFP 阴性的PHC 诊断阳性率分别为78.26%、73.91%和86.96%.如这4项指标联合检测,可使PHC 诊断阳性率达93.6%,特异性提高到90%.     

AFP、CEA、CA199、CA724联合检测在消化道恶性肿瘤中的临床价值

目的探讨检测血清AFP、CEA、CA199、CA724对消化系统恶性肿瘤的诊断价值。方法采用电化学发光法检测45例正常人和155例消化系统恶性肿瘤患者血清AFP、CEA、CA199、CA724含量。结果消化系统恶性肿瘤患者血清AFP、CEA、CA199、CA724含量明显高于正常对照组（P〈0．05）。其中血清AFP含量在肝癌组、CEA含量在结直肠癌组、CA199含量在胰腺癌组、CA724含量在胃癌组中显著高于其他各组（P〈0．05）。联合检测阳性率明显高于单项检测（P〈0．05）。结论AFP、CEA、CA199、CA724检测及联合检测有助于提高消化系统恶性肿瘤的诊断。     

重型肝炎甲胎蛋白测定的临床意义

甲胎蛋白(AFP)阳性常提示是否有肝癌存在,但必须除外妊娠,活动性肝病,生殖腺胚源性肿瘤,因为慢性活动性肝病也可导致AFP暂时性升高。 1 材料与方法我观察了39例重型肝炎,其中,亚急性重型9例,慢性重型30例男35例,女4例。年龄22～67岁,平均44岁。AFP测定系用放射免疫法。试剂由潍坊3V公司提供。重型肝炎每周抽血查凝血酶原活动度(PA)及AFP定量,血清 AFP的变化,并探讨其与预后的关系。     

230例AFP阳性原发性肝癌血清HBV抗原抗体模式分析

原发性肝癌(PHC)与乙型肝炎病毒(HBV)感染的相关性已较明确,为探讨肝癌病人HBV感染状态,我们对230例甲胎蛋白(AFP)阳性确诊为PHC病人的HBV血清标志物进行了检测与分析。1.材料与方法本组230例患者中,男性200例,女性30例,年     

肝癌患者血清AFP、AFU和SHCSP的联合检测

为探讨多种肝癌标志物联合检测对原发性肝癌的临床诊断价值。对79例经B超、计算机断层扫描(CT)诊断为肝癌的患者进行了甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)和特异性肝癌蛋白(SHCSP)的联合检测。单项AFP、AFU和SHCSP法在PHC组的阳性检出率分别为75．95％、72．15％及70．89％，AFP法与AFU法两项联检阳性率为91．14％，AFP法与SHCSP法两项联检，阳性率为89．87％，三项联检的阳性率97．47％，均显著高于任何单项检测的阳性率(χ^2＝15．87，P＜0．005)。AFU法和SHCSP法在19例AFP阴性的PHC病例中，阳性检出率分别为73．6％和68．42％。采用多种肿瘤标志物联合检测，可明显提高肝癌患者的诊断率，对肝癌的早期诊断，尤其对AFP阴性的肝癌诊断具有更重要的临床应用价值。     

ras基因联合血清APF水平与肝癌转移关系的研究

目的 探讨ras基因及AFP水平与肝癌病程的关系。方法 测定50例病理检查确诊的肝癌患者血清AFP水平，并检测其手术切除肝癌组织中ras的表达，分析ras基因及血清AFP联合检测与肝癌有无远处转移及术后复发的关系。结果（1）ras在肝癌组织中阳性表达率为64．0％，ras表达与肿瘤大小、有无肝内转移密切相关（P〈0．05）。ras阳性、阴性表达病例3年复发率分别为65．6％、33．3％。（2）高血清AFP水平且ras阳性病例组3年复发率为76．2％，而低血清AFP且ras阳性病例组3年复发率45．5％，差异显著（P〈0．05）。结论 联合ras基因及血清AFP检测可作为判断肝癌术后复发的有效指标，多因素分析更有价值。     

自制AFP/CEA双标记TRFIA试剂临床应用效果观察

目的 观察自制甲胎蛋白(AFP)及癌胚抗原(CEA)双标记时间分辨荧光免疫分析(TRFIA)试剂的临床应用效果.方法 用自制AFP/CEA双标记TRFIA试剂测定410份血清的AFP、CEA,并将其结果与化学发光法、进口试剂检测结果进行对照.结果 以化学发光法、进口试剂检测结果为金标准,自制试剂检测AFP敏感性、特异性均为97.56％;检测CEA敏感性96.05％,特异性98.06％.自制试剂AFP、CEA指标ROC曲线下面积分别为0.978和0.976.结论 自制AFP/CEA双标记TRFIA试剂检测血清AFP、CEA灵敏度和特异度均较好.     

血清GP73、AFP水平联合病理特征的肝癌术后预测复发模型的价值

目的探讨血清GP73、AFP水平联合病理特征的复发预测模型在评估肝癌术后中的价值。方法选取我院2014年2月至2016年8月肝胆外科就诊的肝癌术后患者90例,肝癌术后患者进行1年的随访,收集患者复发的情况,对患者血清GP73和AFP水平进行检测,通过运用Cox比例风险回归模型对影响患者术后复发的临床参数进行筛选,建立肝癌术后复发预测模型,并运用受试者工作特征曲线(ROC)评估该模型的预测价值。结果①患者6个月、12个月的复发率为22.2%、42.2%,血清GP73 70μg/L、AFP500 U/L、ALT42 U/L、肿瘤的数目≥3个、肿瘤的直径≥4 cm、低分化型、门静脉侵犯合并肝硬化均是肝癌术后复发的独立危险因素。②复发预测模型:预后指数(Prognostic index,PI):0.51×GP73+0.43×AFP+0.51×ALT-1.12×肿瘤数目(2)-1.02×肿瘤数目(1)+1.37×门静脉侵犯-0.73×分化(1)-0.86×分化(2)+0.75×合并肝硬化。预后术后复发的风险随着预后指数的增加不断升高。ROC曲线下面积(AUC)为0.76,预测复发的敏感度和特异度分别为54.7%、86.4%。结论血清GP73、AFP水平联合病理特征能较好的预测肝癌术后复发情况,具有重要的临床价值。     

Macroregenerative nodules in cirrhosis are not associated with elevated serum or stainable tissue alpha-fetoprotein

We have explored the relationship of serum alpha-fetoprotein and macroregenerative nodules (MRNs), possible precursor lesions of hepatocellular carcinoma (HCC), and sought to demonstrate alpha-fetoprotein (AFP) expression in these nodules. One hundred and sixty-eight sequential adult cirrhotic resected livers were examined and MRNs were identified by standard criteria. Pretransplant serum AFP was available for 158 of these patients (normal <20 ng/ml). One hundred and seventy-two randomly selected lesions, including ordinary and atypical MRNs, some containing microfoci of HCC, and HCCs were stained for AFP by immunohistochemistry. In the series, 12 cases had grossly apparent HCCs, four associated with high serum alpha-fetoprotein (p<0.006). Forty-four cases had MRNs, 32 without grossly apparent HCC. Five of these 32 cases were associated with high serum AFP (not significant). Immuno-staining for AFP was seen in three specimens of HCC and in a cirrhotic nodule from a patient without HCC, but not in MRNs. 1) Neither the presence of MRNs – whether ordinary, atypical, or containing micro-foci of HCC – nor that of gross HCC is ruled out by a normal serum AFP. 2) Elevated serum AFP is not associated with the presence of MRNs. 3) MRNs rarely stain for tissue AFP.     

血清高尔基体蛋白73诊断原发性肝癌价值探讨

目的探讨高尔基体蛋白73（GP73）诊断肝癌的价值。方法在肝癌107例、肝硬化53例、肝衰竭患者40例和健康人34例,采用ELISA法检测血清GP73浓度,采用ROC曲线寻找GP73诊断肝癌的最佳截断点,并与AFP进行比较,以评价GP73诊断肝癌的价值。结果原发性肝癌、肝硬化和慢性肝衰竭患者血清GP73水平分别为123.5±22.4ng/ml、108.9±30.3ng/ml和130.3±45.6ng/ml,均显著高于健康对照人群（44.1±38.9ng/ml,P〈0.05）;原发性肝癌、肝硬化和慢性肝衰竭患者血清AFP水平分别为236.6±205.3ng/ml、5.3±5.56ng/ml和53.9±40.40 ng/ml;选择血清GP73最佳截断点为77.4ng/ml,其诊断原发性肝癌的灵敏度为89.6%,特异度为100%,AFP的最佳截断点为35.4ng/ml,其诊断原发性肝癌的灵敏度为64.2%,特异度为100%;原发性肝癌患者血清GP73水平在不同年龄、性别、Edmondson分级和结节数目多寡之间无显著性相差,而在不同肿瘤大小、TNM分期和是否合并肝硬化方面均有显著性差异（P＜0.05）。结论血清GP73诊断肝癌的灵敏度优于AFP,尤其在AFP阴性患者诊断中有一定的意义。     

Alpha-fetoprotein-producing pancreatic cancer--a case report and review of 28 cases.

The case of a female patient with an alpha-fetoprotein (AFP)-producing acinar cell carcinoma of the pancreas is reported, and 28 cases in the literature are reviewed. In our case, the serum AFP level declined drastically after removal of the tumor, but increased when widespread metastases appeared. AFP was detected in the cytoplasm of the cancer cells by immunohistochemical staining. Immunoelectron microscopic studies revealed AFP on the endoplasmic reticulum of the cancer cells. Of the 28 cases with AFP-producing pancreatic cancer, liver metastases were identified in 21 cases (76% overall). There was no correlation between the serum AFP level and liver metastases. Immunohistochemical studies revealed localization of AFP at the primary lesion in 6 out of eight cases tested. In cases of AFP-producing pancreatic cancer, serum AFP levels are useful for the diagnosis and as a marker for evaluating recurrent disease and therapeutic response, and for the management of gastrointestinal disease it should be remembered that some pancreatic cancers produce AFP.     

AFP、AFP-L3％、GP73在肝硬化、肝癌患者血清中的表达及鉴别诊断价值

目的：探讨不同血清肿瘤标志物在肝硬化和肝癌的鉴别诊断中的临床价值。方法回顾性分析146例肝硬化患者、50例原发性肝癌患者的临床资料,并选取50例健康体检者作为对照,分别检测血清AFP、甲胎蛋白异质体（AFP-L3）和高尔基体糖蛋白73（GP73）含量,并计算 AFP-L3％。结果146例肝硬化患者的 AFP 阳性率为平均25．3％,低于肝癌组的72％（χ2＝34．69,P＜0．01）;AFP-L3％在不同病因肝硬化组中阳性率均较低,平均8．9％,低于肝癌组的58％（χ2＝53．32,P＜0．01）,也低于肝硬化组中AFP 的阳性率（χ2＝13．90,P＝0．0002）;GP73在不同病因肝硬化组、肝癌组阳性率均较高,在肝硬化组中平均阳性率为74．7％,高于AFP 及AFP-L3％在肝硬化组中的阳性率（χ2＝71．01,P＜0．01）,与GP73在肝癌组中的阳性率比较差异无统计学意义（χ2＝0．84,P＝0．36）。AFP、AFP-L3％的敏感性、特异性均较GP73好,联合诊断不能提高鉴别准确性。结论血清肿瘤标志物AFP 在乙型肝炎肝硬化及隐源性肝硬化患者中阳性率较高,AFP-L3％在各种病因肝硬化患者中均较低,AFP、AFP-L3％可有效区分肝癌和肝硬化;GP73在不同病因肝硬化组中均高,不能用于区分肝硬化和肝癌。     

Radioimmunoassay of α-fetoprotein in human serum

A radioimmunoassay for human α₁-fetoprotein (AFP) has been developed. Serum AFP level was measured in 136 healthy adults, the mean value±sd being 3.8±1.3 ng/ml of serum. 34 patients with primary hepatocellular carcinomas all had abnormal serum AFP concentrations, values in 5 of them (14%) being lower than 500 ng/ml. 4 of 19 patients with liver metastasis and 39 of 118 patients with nonneoplastic liver diseases had AFP concentrations scattered between the upper limit of normal (7.7 ng/ml) and 500 ng/ml. Thus, a moderately elevated serum AFP level cannot be granted for the diagnosis of malignant hepatoma. Although a transitory rise of AFP concentration was observed in a patient with hemochromatosis and no detectable liver tumor, serum AFP level was found stable with time. Sensitive radioimmunoassays for AFP may prove useful for the follow-up of patients with nonneoplastic liver diseases and a high risk of hepatocellular carcinoma.     

甲胎蛋白与癌胚抗原联合检测在肝癌鉴别诊断中应用价值

目的探讨联合检测甲胎蛋白(AFP)与癌胚抗原(CEA)在原发性肝癌和转移性肝癌诊断中的应用价值。方法选择经临床病理学检查确诊的肝癌患者98例,根据疾病诊断分为原发性肝癌组(56例)和转移性肝癌组(42例),同期健康体检者作为对照组(30例)。采用电化学发光法测定血清AFP和CEA浓度,并对3组结果进行分析。结果原发性肝癌组血清AFP和CEA含量均明显高于对照组(P均0.05),原发性肝癌组血清AFP含量明显高于转移性肝癌组,差异有统计学意义(P=0.012);转移性肝癌组中CEA含量均明显高于原发性肝癌组和健康对照组,差异有显著统计学意义(P均0.01)。结论联合检测血清AFP和CEA的含量能更好地诊断和鉴别诊断原发性肝癌与转移性肝癌,对鉴别肝癌的类型具有一定的指导意义。     

血清AFP,GGT-II和GGT联合检测诊断原发性肝癌的价值探讨

目的探讨联合检测血清AFP、GGT-II和 GGT在诊断原发性肝癌中的价值,以提高原发性肝癌的早期诊断率.方法选择PLC 36例、肝硬化63例、病毒性肝炎78例、肝损伤14例、肝良性肿瘤8例和正常对照者46例,血清AFP,GGT-Ⅱ及GGT分别采用化学发光免疫分析法、自然不连续缓冲系统聚丙烯酰胺凝胶垂直电泳检测法和全自动生化仪进行检测.结果 PLC组AFP为3285±932μg/L,GGT为297±201U/L,显著高于肝硬化组（AFP：414±285μg/L,P〈0.01;GGT：222±149U/L,P〈0.05）、病毒性肝炎组（AFP：114±114μg/L,P〈0.01;GGT：181±134 U/L,P〈0.05）,肝损伤组（AFP：20±20μg/L,P〈0.01）,肝良性肿瘤组（AFP：4.4±2.9μg/L,P〈0.01;GGT：201±111 U/L,P〈0.05）及正常对照者组（AFP：3.2±1.1μg/L,P〈0.01;GGT：31±6.1U/L,P〈0.05）;诊断肝癌的特异性AFP最高（90%）,灵敏度最高为GGT-Ⅱ（92%）;将三者联合检测,则诊断原发性肝癌的灵敏度可达到95%.结论肿瘤标志物的联合检测可提高原发性肝癌的确诊率,具有较好的临床应用价值.     

良性肝病甲胎蛋白异常者5年随访

探讨AFP升高的良性肝病患者原发性肝癌发生率。对AFP升高的 16 4例良性肝病患者追踪随访 5年 ,每 3个月一次检测AFP、肝功能、B超等。 8例急性肝炎及 6例重型肝炎均无恶变 ,而肝硬化恶变为 14 6 % (7/48) ,明显较慢性肝炎 3 9% (4/10 2 )高 (P <0 0 5 ) ,AFP动态观察中 ,一过升高型、反复波动型、持续低浓度型、稳定上升型发生恶变分别为 0 % (0 /36 )、4 2 % (1/2 4 )、6 9% (7/10 1)、10 0 % (3/3)。对AFP升高的慢性肝病患者 3个月一次的追踪随访 ,可早期发现原发性肝癌。     

A clinical evaluation of serum alpha-1-antichymotrypsin levels in liver disease and cancers

The serum levels of alpha-1-antichymotrypsin (ACT) were studied in 168 patients with various liver diseases and cancers in conjunction with other liver function tests, serum sialic acid, AFP and CEA. The ACT levels in acute viral hepatitis and chronic hepatitis were not significantly altered compared with the normal level (220 +/- 40 microgram/ml), although the level was slightly increased or decreased temporarily during the acute phase of the former. In liver cirrhosis, the mean level was significantly lower than the normal in spite of the absence of signs of hepatic decompensation (168 +/- 51 microgram/ml, p less than 0.001). In contrast to cirrhosis, the levels were increased to various extents in 65% of cases with hepatoma, in spite of the association of liver cirrhosis in the majority of them. Much higher levels were observed in all cases of metastatic liver cancers and cancers of the pancreas and the biliary tract. The elevations were observed even in cases without the increase of AFP or CEA. Both in cirrhosis and cancers, ACT levels were not correlated with any of serum bilirubin and serum enzyme activities, but were positively correlated with the levels of plasma fibrinogen and serum sialic acid. The measurement of serum ACT level can be taken advantage of for the diagnosis and monitoring of liver cirrhosis and liver cancers, particularly of hepatoma without AFP elevation.     

Highly enhanced fucosylation of serum glycoproteins in patients with hepatocellular carcinoma

BACKGROUND: We recently reported that the measurement of Lens culinaris agglutinin-reactive species of alpha-fetoprotein (AFP), alpha-1-antitrypsin (AAT) and transferrin (TF) is useful for the diagnosis of hepatocellular carcinoma (HCC) and that the molecular basis for this reactivity is fucosylation at the innermost N-acetylglucosamine residue of a biantennary sugar chain. However, the precise relationship of the fucosylation of AFP, AAT and TF in patients with HCC and liver cirrhosis is not fully understood. The aim of this study is to delineate the relationship of the fucosylation between these three glycoproteins in HCC. METHODS: Three hundred and thirty-four patients with HCC were referred to our university hospital from 1987 to 1997. An increase in serum AFP (> 20 ng/mL) was observed in 233 (69.8%) patients with HCC. From these 233 patients with AFP-producing HCC, 60 serum samples were randomly selected and used in the present study. As a reference, samples from 60 patients with liver cirrhosis, in which 30 had increased AFP, were used. Lens culinaris agglutinin (LCA)-reactive species were determined by crossed immunoaffinoelectrophoresis (CIAE). The contents of the fucosylated biantennary chain of purified AAT and TF samples were determined as pyridylamino derivatives of each oligosaccharide with high-performance liquid chromatography (HPLC). RESULTS: There was a highly significant correlation between LCA-reactive species by CIAE and pyridyl-amino-fucosylated biantennary sugar chain by HPLC in both AAT and TF. Lens culinaris agglutinin-reactive species of AFP, AAT and TF in HCC were significantly higher than those in liver cirrhosis. A highly statistically significant positive correlation of fucosylated glycans was observed between AAT and TF in both HCC and liver cirrhosis, but not between AFP and AAT or between AFP and TF. Accordingly, the present results indicate that highly enhanced fucosylation of serum glycoproteins was found in HCC compared with liver cirrhosis and that the combination of measurements of fucosylated AFP with AAT or TF were useful for the diagnosis of HCC.