Alpha-fetoprotein, prealbumin, albumin, alpha-1-antitrypsin and transferrin as diagnostic and therapeutic markers for endodermal sinus tumors.

According to Gitlin, alpha-fetoprotein (AFP), albumin, prealbumin, alpha-1-antitrypsin and transferrin are normal products of the human yolk sac. They are expected to reappear in human endodermal sinus tumor (yolk sac tumor). The synthesis of alpha-fetoprotein and other serum proteins by human endodermal sinus tumor was studied in the culture cells and in the tumor tissue transplanted into nude mice. The results gave evidences of synthesis of some of these proteins including alpha-fetoprotein and alpha-1-antitrypsin. Serum concentrations of these proteins were studied in eight children having endodermal sinus tumors. Serum AFP levels were abnormally high in all cases, whereas concentrations of other serum proteins were almost within normal ranges. This might be simply reflected by the fact that pre-albumin, albumin, alpha-1-antitrypsin, and transferrin are already present in large quantities in sera of normal subjects while alpha-fetoprotein is present only in a negligible quantity. Alpha-fetoprotein, as a diagnostic and therapeutic marker of endodermal sinus tumor, showed good correlation to the tumor growth. Serum AFP concentrations declined almost to 0 ng/ml with a half-life of 4 days when surgical removal was complete, whereas serum AFP decreased only to 100-200 ng/ml with radiation and chemotherapy alone.     

The impact of protease inhibitors on maternal serum screening analyte levels in pregnant women who are HIV positive

OBJECTIVE: The purpose of this study was to compare alpha-fetoprotein, human chorionic gonadotropin, and unconjugated estriol levels in women who take protease inhibitors and those women who do not. STUDY DESIGN: This retrospective review from August 2000 to May 2003 was performed for maternal serum screen results, medication use, pregnancy, and perinatal outcomes. RESULTS: Thirty-nine women met study criteria. Sixteen women were treated with protease inhibitors, and 23 women were not treated with protease inhibitors. There was no difference in initial viral load or initial CD4 count between the groups. No difference was found for human chorionic gonadotropin and estriol levels; significantly lower alpha-fetoprotein multiples of the median were found for the women who were treated with protease inhibitors compared with the women who were not (0.97 +/- 0.32 [SD] MoM vs 1.2 +/- 0.4 MoM, respectively; P = .04). Six of 39 women (15%) had positive maternal serum screens. All the babies were normal at birth, and there were no cases of perinatal transmission of human immunodeficiency virus. CONCLUSION: Protease inhibitors are associated with lower alpha-fetoprotein levels in women who are infected with human immunodeficiency virus.     

原发性肝癌患者血清AFU、AFP、AKP检测的临床意义

目的探讨a-L岩藻糖苷酶(AFU)、甲胎球蛋白(AFP)、碱性磷酸酶(AKP)联合检测在原发性肝癌(PHC)中的诊断价值。方法AFP采用化学发光法;AFU、AKP采用速率法。检测30例原发性肝癌(PHC)患者血清AFU、AFP、AKP及45例正常对照组。结果原发性肝癌患者血清AFU、AFP、AKP水平明显高于正常对照组,有显著性差异(P<0.05)。结论AFU、AFP、AKP联合检测可以提高对原发性肝癌诊断的准确性。     

Radiolabelled monoclonal antibodies against alpha-fetoprotein for in vivo localization of human hepatocellular carcinoma by immunotomoscintigraphy

Two high affinity monoclonal antibodies, designated AF01 and AF04, directed against distinct epitopes of human alpha-fetoprotein (AFP) and the Fab fragments of one of them, were labelled with ¹³¹I and injected into 18 patients with AFP producing hepatocellular carcinoma (HCC) in order to carry out imaging studies by tomoscintigraphy. Twelve patients were injected with whole antibody, only three of seven patients injected with AF01 and two of five patients injected with AF04 had a positive scan. In contrast, five out of six patients injected with labelled Fab fragments of AF04 had positive imaging. These results confirm that tumour imaging of HCC using ¹³¹I labelled monoclonal antibody against AFP is feasible. Moreover, utilization of tomoscintigraphy in place of linear scintigraphy and Fab fragments instead of whole immunoglobulin may improve the sensitivity of radioimmunolocalization. This technique provides useful information on the in vivo distribution of monoclonal antibodies directed against AFP and on the practicability of the eventual therapeutic use of anti-AFP antibodies in HCC.This work was supported by Grant number 84D16 from the Institut Gustave-Roussy     

卵巢肝样癌1例报道并文献复习

目的探讨卵巢肝样癌的病理学特点、诊断及鉴别诊断。方法对1例卵巢肝样癌进行光镜、免疫组化检测。结果卵巢肿瘤由类似肝细胞癌样的细胞组成，排列呈片状、巢状，瘤细胞体积大，胞质丰富，嗜酸性，胞核圆形、卵圆形位于中央，可见核仁，分裂象活跃。AFP( )、HCG( ／-)，而CA-125、CEA、CK、EMA、Inhibin、ER、PR、Mac387、KP-l和HMB45均(-)。CD34显示丰富的毛细血管。PAS(-)。结论卵巢肝样癌是一种非常罕见的恶性肿瘤，组织学形态需与肝样卵黄囊瘤、类固醇细胞瘤或脂质细胞瘤、卵巢转移性肝细胞癌、恶性黑色素瘤等鉴别。     

10442例孕中期孕妇胎儿唐氏综合征的筛查分析

目的评价产前唐氏综合征(DS)筛查的临床应用价值。方法应用Beckm an Cou lter公司Access全自动分析仪对10 442例孕中期孕妇血清进行甲胎蛋白(AFP)、总β绒毛膜促性腺激素(TβHCG)及游离雌三醇(uE3)3项指标检测,并用专用软件分析,预测胎儿患DS的风险。结果10 442例中,DS高风险526例,其中373例作了羊水细胞培养染色体核型分析,确诊21三体7例。在筛查阴性的9 916例中,出生DS患儿4例,经外周血染色体核型分析证实为21三体。该筛查方法的筛查阳性率5.04%,筛出率63.64%。结论孕中期母血清筛查是预防DS患儿出生的重要途径,这一筛查系统同样适合于中国人群,对特殊人群采用特殊处理方法可使筛出率提高至81.82%。     

大剂量联苯双酯治疗血清甲胎蛋白水平升高的慢性乙型肝炎的初步观察

目的观察大剂量联苯双酯(DDB)对血清甲胎蛋白(AFP)水平升高的慢性乙型肝炎的疗效。方法26例血清AFP水平升高的慢性乙型肝炎患者采用DDB治疗,剂量为67.5mg/d(22.5mgtid)~135mg/d(45mgtid),连续治疗。治疗期间每隔4周检测AFP、肝肾功能。结果治疗后主要症状均有明显改善(P<0.01);治疗后AFP水平较治疗前明显降低(52.3±92.6μg/L对280.0±315.2μg/L,t=3.5338,P<0.001);治疗后血清ALT、AST水平均较治疗前明显下降(P<0.05~0.001)。未见明显副作用。结论DDB对血清AFP升高的慢性乙型肝炎有明显的治疗效果,除了保肝降酶作用外,它还可降低血清AFP水平。     

肝病患者血清中AFP检测的临床意义

目的探讨在肝病患者血清中AFP水平的变化及临床意义。方法采用放射免疫分析对50例正常组和198例肝病组进行血清AFP水平的检测。结果急性肝炎、肝硬化伴腹水、原发性肝癌的患者治疗前血清AFP水平非常地高于正常组（P〈0．01）,后经治疗后AFP比治疗前有非常显著下降（P〈0．01）。而慢性肝炎、肝硬化无腹水的患者血清AFP水平显著高于正常组（P〈0．05）。肝血管瘤组的患者血清AFP水平与正常组比较无差异（P〉0．05）。结论对血清中AFP的检测不仅能作为原发性肝癌的一个肿瘤标志物,而且是监测肝病活动的一个较好指标,对预后观察有重要的临床意义。     

实验室胎儿甲胎蛋白参考水平的建立

目的探讨产前筛查孕妇血清甲胎蛋白（AFP）的水平与胎儿发育状况的关系,建立本实验室参考水平。方法采用放射免疫分析法对600例及经筛选重复测定180产前孕妇进行血清AFP的测定。结果随着胎儿的生长和孕期延长,孕妇甲胎蛋白（AFP）值增高。结论正常孕中期孕母血中的AFP中位数值与孕周呈正相关关系,每个孕期升高在一定的幅度范围内。     

探讨标记物分析前变异在产前筛查质量控制中的影响

目的探讨分析前变异在产前筛查中对测定结果的影响,建立标准的分析前质量管理程序。方法检测不同采血管的类型、处理温度和时间条件下血清甲胎蛋白（AFP）和游离β-人绒毛膜促性腺激素（free13-HCG）值,利用方差分析和t检验计算分析前变异。结果与真空促凝管相比,2～8℃条件下放置7d的分离胶管样本,AFP的测定值差异有统计学意义（P〈0．05）,不同温度和延长水浴时间分离血清检测freeB—HCG值差异有统计学意义（P〈0．05）。结论分析前变异会影响AFP和free β—HCG的测定结果,采用分离胶管执行样本条码化测定可降低分析前处理的不合格率和差错率。