血清r—谷氨酰转肽酶同工酶对AFP阴性肝癌的诊断价值

本文收集1984年9月至1988年6月在我院手术的AFP阴性肝癌及非肝癌肝占位性病变59例。术前用4～30％聚丙烯酰胺梯度凝胶电泳法测定其血清r—谷氨酰转肽酶同工酶。此同工酶的Ⅰ＇、Ⅱ、Ⅱ＇带为原发性肝癌特异性区带。AFP阴性肝癌出现特异性区带者占66.7％(22/33),转移性肝癌占10％(1/10)肝血管瘤等不出现特异性区带。结果表明r—谷氨酰转肽酶同工酶对AFP阴性肝癌的诊断有较大意义。     

HS-AFP GGT-Ⅱ及AFP预测肝硬化癌变的临床价值

目的:探讨肝癌特异性甲胎蛋白(HS-AFP)、甲胎蛋白(AFP)和γ-谷氨酰转肽酶同工酶Ⅱ(GG-Ⅱ)对肝硬化患者肝癌发生风险的预警价值.方法:HS-AFP采用聚丙烯酰胺凝胶电泳技术(PAGE)结合Westem blot分离检测.AFP采用放射免疫分析测定法.GGT-Ⅱ采用PAGE分离检测.对341例肝硬化患者进行跟踪随访18个月,了解肝癌发生情况,分析比较HS-AFP、GGT-Ⅱ和AFP预测肝硬化患者发生肝癌风险的价值.结果:6、12、18个月随访期内HS-AFP、GGT-Ⅱ两项指标阳性组癌变率高于阴性对照组;随访12个月以上AFP阳性组癌变率高于阴性对照组;HS-AFP、GGT-Ⅱ阳性组癌变率高于AFP阳性组,但前两者差异不明显;HS-AFP与GGT-Ⅱ及AFP之间存在互补性,其中HS-AFP和GGT-Ⅱ联合检测预测肝硬化癌变的敏感性、特异性和准确度分别达71.6%、91.4%、91.6%.结论:HS-AFP、GGT-Ⅱ和AFP对肝硬化癌变均有预测价值;HS-AFP和GGT-Ⅱ预测肝癌的特异性、准确度优于AFP;HS-AFP与GGT-Ⅱ预测肝癌的特异性、准确度相似;多项指标联合检测可提高预测肝硬化癌变的敏感性、特异性和准确度.以HS-AFP和CGT-Ⅱ联合检测效果最优.     

5′-核苷酸磷酸二酯酶同工酶对肝癌的临床意义

目前,甲胎蛋白(AFP)仍是诊断原发性肝癌(PHC)最特异的肿瘤标志,但尚有10～30％的病人其血清AFP为阴性,35～40％的PHC病人血清AFP值<400ng/ml。这些AFP低浓度阳性或阴性PHC以及某些良性肝病患者出现的AFP假阳性,给临床诊断带来一定困难。为此,还需寻找另外肝癌标志以弥补AFP的不足。本文试对5′-核苷酸磷酸二酯酶(5′-NPDase)同工酶对肝癌,尤某是AFP低浓度阳性或阴性肝癌的临床意义,作一综述。     

单抗免疫酶斑点法检测GGT-Ⅱ在肝癌诊断中的价值

背景与目的：肝癌特异性γ-谷氨酰转肽酶同工酶Ⅱ(gamma-glutamyltransferase isoenzymeⅡ,GGT-Ⅱ)被认为是甲胎蛋白(AFP)以外的最佳肝癌标志物,但目前尚无简便的检测方法。本研究目的是探讨单克隆抗体免疫酶斑点法检测GGT-Ⅱ对肝细胞癌的诊断价值。方法：纯化GGT-Ⅱ同工酶,免疫BALB／c小鼠,利用杂交瘤技术制备单克隆抗体。采用免疫酶斑点法与电泳法同步检测123例肝癌和164例不同良性肝病患者血清中GGT-Ⅱ。结果：单克隆抗体免疫酶斑点法检测GGT-Ⅱ对肝细胞癌的诊断阳性率(71．5％)与电泳法(76．4％)相比无明显差异。但免疫酶斑点法假阳性率(肝硬化23．7％,慢性肝炎27．1％)高于电泳法(肝硬化10．0％,慢性肝炎8．4％)。结论：单克隆抗体免疫酶斑点法检测GGT-Ⅱ对肝细胞肝癌诊断有一定价值,但诊断特异性有待提高。     

醛缩酶同功酶A及其对原发性肝癌的临床意义

目前,甲胎蛋白(AFP)仍是诊断原发性肝癌(PHC)的最特异的肿瘤标志,但尚有10～30％的PHC病人其血清AFP为阴性,35～40％的PHC病人血清AFP值<400ng/ml。这些AFP低浓度阳性或阴性PHC以及某些良性肝病患者出现的AFP假阳性,给临床诊断带来一定的困难。为此,还需寻找AFP以外的肝癌标志以弥补AFP的不足。本文依据现有的一些国内外资料,试对醛缩酶同功酶A(ALD—A)对PHC的临床意义,作一综述。     

几种较特异的肝癌标志对原发性肝癌的临床意义

目前,甲胎蛋白(AFP)仍是诊断原发性肝癌(PHC)的最特异的肿瘤标志,但有10～30％病人,血清AFP为阴性,35～40％的PHC病人血清AFP测定值相似文献   

血清α—L一岩藻糖甙酶含量诊断原发性肝癌有关问题的评价

本文对原发性肝癌354例、转移性肝癌123例、肝血管瘤38例、肝囊肿32例、肝硬化52例、慢性乙肝202例、正常人对照106例，共计907例进行了血清a—L一岩藻糖甙酶（AFU）的测定，其敏感性、特异性、阳性预报率与阴性预报率准确度分别89．8％、93．1％、89．3％、93．5％、91．8％。AFU活性与甲胎蛋白（AFP）浓度间均无明显相关性。AFU与AFP联合检测对原发性肝癌的诊断阳性率达94．6％     

AFP阴性的肝脏占位性病变37例误诊分析

自广泛采用AFP检测以来,仍有30％左右的原发性肝癌(下称肝癌)病例AFP阴性,而肝脏其它占位性病灶有时也可出现与AFP阴性肝癌相似的临床表现及B超图象,鉴别诊断困难。本文将1972年1月——1988年2月,经病理证实被误诊的37例AFP阴性肝脏占位性病变作一分析,以求从中得到启示,提高确诊率。 临床资料 37例中,男25例,女12例。年龄20—71岁。B超或CT检查均示肝区有占位灶。均由手术或穿刺病理确诊,见附表。 所有病例均作SGDT及AKP测定,仅在肝硬变     

肝癌血清酶学诊断

多数肝癌患者有以下三方面的生化变化:①出现胚胎性抗原,如甲胎蛋白(AFP)和胎儿类型的同工酶;②激素过度合成,如PTH和红细胞生成素等;③出现异常脂肪酸和高胆固醇血症。上述某些生化变化已用作检测肝细胞性肝癌的指标,其中以AFP 试验较为敏感。然而,即使用敏感的放射免疫定量测定,仍有约10%肝癌患者AFP 阴性,有待进一步解决。近年来,测定某些血清酶及其同工酶诊断原发性肝癌取得了有意义的进展。如与AFP同时测定,对原发性肝癌的诊断有互补作用。     

巢式逆转录聚合酶链反应检测肝癌患者外周血AFP mRNA的临床意义

目的 评估肝细胞癌(HCC)患者外周血甲胎蛋白mRNA(AFP mRNA)检测的临床意义。方法 采用巢式逆转录聚合酶链反应技术，对肝癌患者外周血AFP mRNA进行检测。结果 37例肝癌患者中AFPmRNA阳性16例(43，2％)，25例肝硬变患者中AFPmRNA阳性2例(8.0％)，20例正常对照无1例阳性；AFP mRNA阳性的HCC患者肝外转移发生率(87．5％)显著高于AFP mRNA阴性的HCC患者(33．3％)，差异有显著性(x^2=10．856，P≤0.001，OR=14.00，95％可信区间CI=2．464～79.550)；不同临床分期的HCC患者其AFP mRNA检出率不同，Ⅲ期患者检出率(61．9％)明显高于I、Ⅱ期检出率(18．8％)；AFP mRNA的检出率与血清AFP水平不同无明显相关。结论 巢式RT—PCR方法是检测外周血残癌细胞AFP mRNA的一种灵敏可靠技术，检测外周血中的AFP mRNA可能对判断肝癌有无血行播散和病程的发展具有重要意义。     

New abnormal isoenzyme of 5'-nucleotide phosphodiesterase in the serum of human hepatoma

5'-nucleotide phosphodiesterase (5'-NP) isoenzymes were separated from the serum of human primary liver cancer (PLC) patients by 4-20% tubular polyacrylamide gel gradient electrophoresis. Electrophoresis showed 11 isoenzymes in which bands I, V and VI (from anode to cathode) were all absent in 125 normal control sera; bands V and VI were detectable in 31(73.8%) of 42 patients with PLC, but absent in 70 cases of other diseases. Bands V and VI may represent specific isoenzyme bands of PLC, comprising a new addition to the markers used in the diagnosis of this disease. By the same method, it was also found that the abnormal serum isoenzyme bands of PLC correspond to those found in the cord blood sera of the newborn and fetus. These abnormal isoenzymes diminish gradually after birth and all disappear when children reach the age of 10.     

The significance of new abnormal isoenzymes of 5'-nucleotide phosphodiesterase in the diagnosis of human liver cancer

In 1986, we reported that abnormal 5'-nucleotide phosphodiesterase (5'-NP) (oligonucleate: 5'-nucleotidohydrolase, EC 3.1.4.1) isoenzymes (5'-NP I and 5'-NP V + VI) were observed in the serum of patients with liver cancer. The results of the present study show that the 5'-NP I positivity rate is 99.2% (234/236), specificity 74.9%; and the 5'-NP V + VI positivity rate is 77.5% (183/236), specificity 95.3% in liver cancer. 5'-NP I positivity rate is 86.7% (13/15) and 5'-NP V + VI positivity rate is 46.7% (7/15) in metastatic liver cancer. These 3 abnormal isoenzyme bands were all present in the serum of 6 patients with liver cancer before radical resection and disappeared after successful resection, but they were all present in the serum of 6 other liver cancer patients before and after palliative operation. In 2 cases of small liver cancer (diameter less than 4cm), 5'-NP I and 5'-NP V + VI were strongly positive. It may be considered that the new 5'-NP abnormal isoenzyme bands are specific markers and will be useful for diagnosis of human liver cancer.     

Clinical evaluation of specific gamma-GTP isoenzyme in patients with hepatocellular carcinoma

The authors evaluated specific gamma-GTP isoenzyme (specific gamma-GTP) found in sera of patients with hepatocellular carcinoma (HCC). In addition to band II and II' which had been reported in our previous publication, band I' also had a high specificity for HCC. One or more of these bands were detectable in 109 (55%) of 200 patients with HCC, but only in seven (3%) of 279 patients with other hepatobiliary diseases. Specific gamma-GTP was found in 38% of HCC patients with alpha-fetoprotein (AFP) levels below 400 ng/ml. The incidence of this isoenzyme was independent of the clinical stage as classified by liver scanning. Even in Stage I, where filling defects were not seen, the incidence was 52%. We conclude that the specific gamma-GTP is useful in diagnosis of HCC patients with low levels of AFP or at a relatively early stage.     

Clinical significance of serum "hepatoma-specific" gamma-glutamyl transferase and alkaline phosphatase

By means of polyacrylamide gel stage electrophoresis designed by us, serum gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) were separated into 9 (I to IX) and 7 (I to VII) isoenzyme bands. The GGT II and ALP I were found only in the sera of patients with primary hepatic carcinoma showing positive rates of 29.5% and 8.5%, respectively. The combined positive rate of the two kinds of isoenzymes was 36.2% which is lower than that of alpha-fetoprotein (AFP) in the liver cancer but it has a higher specificity compared to the latter test. Furthermore, positive GGT II and ALP I may also be present in patients with liver cancer who were negative for AFP. It is obvious that the simultaneous determinations of GGT II, ALP I and AFP are mutually supplementary in the diagnosis of liver cancer.     

上海市肝癌高危人群监测方案实施评估

目的：评价上海市肝癌高危人群的监测方案,方法：以35岁－55岁的乙肝抗原抗体阳性或有慢性肝炎史的18816名上海市民随机分为筛查组（9373人）与对照组（9443人）。筛查组每六个月作一次AFP与实时超声检查,检出的可疑病例即进入诊断程序,一旦确诊,且有手术指征者皆动员作手术切除;对照组不作任何主动检查,但发病的肝癌病人亦同样为之争取手术切除或其他积极的治疗,并随访其生存期。结果：筛查组共筛查38444人年,检出肝癌86例,对照组共观察41077人,发现肝癌67例,两组肝癌病例相比,筛查组Ⅰ期肝癌占60．5％,对照组为0（P＜0．01）。筛查组小肝癌占45．3％,对照组为P（P＜0．01）。筛查组能作手术切除的占46．5％,而对照组为31．2％、7．2％、0和0。筛查组中肝癌死亡率为83．2／10万,对照组为131．5／10万,两组肝癌死亡率比为0．63,结论：S一研究结果说明筛查确能检出早期肝癌。通过积极治疗,筛查组肝癌病人的远期生存率显著高于对照组,肝部二级预防确能降低肝癌的死亡率。     

A clinical and radiologic study of primary liver cancer associated with extrahepatic primary cancer.

In a consecutive series of 393 patients with excised and pathologically proven primary liver cancer (PLC)--including 374 hepatocellular carcinomas (HCC), nine cholangiocellular carcinomas (CCC), and ten mixed type of HCC and CCC--33 patients (8.4%) had one or two other malignancies in the extrahepatic organ(s). Of these, 29 had double cancers and four, triple cancers. This was synchronous in 11 patients, metachronous in 20 (including 18 with double cancers and two with triple cancers) and synchronous and metachronous in two with triple cancers. Metachronous cancer was found in 21 patients 1 year before hepatectomy for PLC and in three patients, 1 year after hepatectomy. The median age of PLC patients with multiple primary cancer (MPC) was 63.6 +/- 6.9 years; this was significantly greater than that of PLC patients without MPC (P less than 0.01). The associated cancer was gastric cancer in 11 patients (29.7%), colorectal cancer in six, pharyngeal cancer in four, and other cancers in ten different organs in 16. Thirteen of 22 patients had a history of blood transfusion. The incidence of liver cirrhosis in PLC associated with MPC (57.6%) was significantly lower than that without MPC (82.8%, P less than 0.01). The differential diagnosis of PLC from liver metastasis was possible retrospectively in 78.6% using sonograms, 79.3% using computed tomograms, and 91.3% using angiograms. The survival rates of patients with PLC with (n = 33) and without (n = 299) MPC who had undergone hepatectomy were 97.0% and 85.4% at 1 year, 55.5% and 59.5% at 3 years, and 40.5% and 40.1% at 5 years, respectively. There was no significant difference between the survival rates of those who underwent operations for PLC and extrahepatic primary cancer(s) synchronously and metachronously.     

原发性肝癌患者HBV感染血清学模式调查

目的 :研究HBV感染血清学模式与原发性肝癌的关系。方法 :分析 1996年 6月～ 2 0 0 0年 9月我院收治的 50 0例原发性肝癌患者的HBV感染血清学模式 ,与同期收治的 50 0例其他恶性肿瘤患者的HBV感染血清学模式进行比较。结果 :原发性肝癌患者HBV感染率为 89 6% ,显著高于其他恶性肿瘤患者。HBsAg和HBcAb同时阳性者占HBV感染肝癌的 79 9% ,占HBV感染其他恶性肿瘤的13 3% ,差异有极显著性 (P <0 0 1)。出现HBsAb者占原发性肝癌中HBV感染病例的 8 5% ,其他恶性肿瘤中HBV感染病例的 75 1% ,两者差异亦有极显著性 (P <0 0 1)。“大三阳”、“小三阳”和 (HBsAg HBcAb )者与肝癌相关的OR分别为 13 85、6 95和 14 69。结论 :HBsAg和HBcAb同时阳性的患者患肝癌的危险性最高 ;血清出现HBsAb的HBV感染者不易发展成肝癌     

原发性肝癌诊断中血清α—L—岩灌糖苷酸的价值

探讨血清α－Ｌ岩藻糖苷酶在原发性肝癌诊断中的应用价值。方法设定原发性肝癌组、继发性肝癌组、肝硬化组、正常对照组,比较各组测定的ＡＦＵ水平;在原发性肝癌组中做血清ＡＦＵ水平与ＴＮＭ分期相关性分析并统计ＡＦＵ及ＡＦＰ阳性率;比较接受有效治疗前后原发性肝癌患ＡＦＵ水平的变化。结果原发性肝癌组与其他各组比较,ＡＦＵ差异均有显性。血清ＡＦＵ水平与原发性肝癌ＴＮＭ分期呈正相关,其中ＡＦＵ阳性率７６．６％,     

Resection of the primary liver cancer of the hepatic hilus.

Primary liver cancer (PLC) of the hepatic hilus was designated as a tumor situated at the main branch of the portal vein or pedicle of the hepatic veins in contact with the intrahepatic vena cava. That is, the main tumor located at segment I, IV, V, or VIII and concentrating on the central part of the liver was called "the central type of PLC," which differed from a tumor located at segment II, III, VI, or VII; the latter was called "the peripheral type of PLC." Surgical treatment of the PLC has been significantly improved in the past two decades, but the resection of the central type of PLC is difficult and hazardous. This institution admitted 903 PLC from January 1970 to April 1988, of which 118 cases were the central type; 65 cases were resected successfully, a resectability of 55.1%. One patient died from sepsis within 1 month of operation (mortality 1.53%). The modes of operation for the different segments are described, and suggestions for improvements are presented. The survival rates were compared with a similar number of patients with the peripheral type of tumor in the same period and treated by the same surgeons. The results show noticeable differences. The one-year, three-year, and five-year survival rates after resection were 70.9%, 43.2%, and 39.2% in the central type of PLC; they were 98.3%, 85.0%, and 76.4% in the peripheral type of PLC (P less than 0.001). Further discussion of improvements in surgical techniques and mental awareness are suggested.     

原发性肝癌Twist基因表达的研究

目的：研究Twist基因在人原发性肝癌（primary liver cancer,PLC）组织中的表达及其临床意义。方法：应用免疫组织化学SABC染色方法检测45例PLC组织及癌旁组织中Twist蛋白并采用RT-PCR对TwistmR-NA的表达进行分析研究。结果：PLC组织、癌旁组织及正常肝组织中Twist的阳性表达率分别为80.0%、57.8%和22.2%。PLC和癌旁组织与正常对照肝组织中Twist的表达相比较差异均有统计学意义,P〈0.05。肿瘤包膜也可见Twist表达。RT-PCR检测Twist结果显示,PLC组织中Twist mRNA表达显著上调。结论：PLC组织中高表达转录因子Twist对肿瘤的发生、发展起着重要作用。