新微量离心柱法测定甲胎蛋白异质体对原发性肝癌诊断的价值（附297例分析）

目的探讨新微量离心柱法测定甲胎蛋白异质体（AFP—L3）在良性肝病及原发性肝癌预警中的作用。方法以装有祸联小扁豆凝集素（LCA）的微量离心柱分离慢性肝炎组、肝硬化组、原发性肝癌组共297例的患者血清甲胎蛋白异质体,用罗氏E170电化学发光免疫分析仪检测分离前AFP和分离后AFP（AFP—L3）,计算AFP—L3在AFP中的含量比例[AFP-L3（％）]。结果原发性肝癌组AFP-L3（％）均值、阳性率与慢性肝炎、肝硬化组相比均显著增加（P〈0．001）,AFP低浓度（AFP〈200μg／L）原发性肝癌组AFP-L3（％）与慢性肝炎、肝硬化组相比也显著增加（P〈0．001）;而在原发性肝癌组中,不同AFP浓度组的AFP-L3（％）均值与阳性率相比,差异无统计学意义（P〉0．05）。结论新微量离心柱法测定AFP—L3（％）对肝癌和良性肝病的诊断具有重要意义,尤其对低浓度原发性肝癌和良性肝病的鉴别诊断具有重要的临床价值。     

Immunotherapy for hepatocellular carcinoma: Current status and future perspectives

Hepatocellular carcinoma(HCC) is one of the world’s deadliest and fastestgrowing tumors, with a poor prognosis. HCC develops in the context of chronic liver disease. Curative resection, surgery(liver transplantation), trans-arterial chemoembolization, radioembolization, radiofrequency ablation and chemotherapy are common treatment options for HCC, however, they will only assist a limited percentage of patients. Current treatments for advanced HCC are ineffective and aggravate the underlying live...     

甲胎蛋白的生物学功能

甲胎蛋白(AFP)不仅是肝细胞癌诊断的重要标志物,还在肝癌细胞的生长、增殖及凋亡等过程中发挥着重要的生物学作用.除了胞外的配体结合和运输功能,以及作为生长调控因子刺激肿瘤细胞生长外,细胞内的AFP还可以通过和转录因子或一些关键蛋白之间发生相互作用而作为信号分子参与对下游基因的转录调控或对信号通路产生影响.这些为我们研究...     

AFP血清浓度及肝癌组织中Cx43的表达与肝癌根治切除后早期复发和预后的关系

目的 研究Cx43、CD105、VEGF在不同血清AFP(α-fetoprotein)浓度的乙型肝炎病毒性肝细胞癌(hepatocellular carcinoma,HCC)组织中的表达的关系以及Cx43的表达和RO切除术后复发和预后的关系.方法 应用组织芯片技术和免疫组织化学PV-6000两步法检测234例HBV相关HCC组织标本Cx43和CD105、VEGF的表达,应用RT-PCR检测20例HBV相关HCC标本Cx43mRNA的表达,并分析在不同血清AFP浓度下与Cx43的表达与CD105、VEGF的表达的关联以及与HCC患者根治切除术后的复发和预后的关系. 结果 免疫组织化学法和RT-PCR均检测到Cx43在HCC组织中表达,AFP＜ 400 μg/L的HBV相关HCC组织中Kaplan-Meier分析显示Cx43阳性表达者其1年复发、无瘤生存和总体生存均显著低于阴性表达组(Log Rank P =0.001,0.026,0.000),Cox回归分析表明Cx43阳性表达是HCC早期复发和预后(Log Rank P=0.049、0.035)的独立影响因子,Cx43阳性表达者CD105、VEGF低表达(P=0.018、0.023),并与组织分化程度(P =0.002),病灶数(P =0.033)血管癌栓(P =0.029)有关.结论 Cx43的表达与CD105、VEGF的表达相关,在AFP＜400 μg/L的HBV相关HCC的患者中Cx43阴性表达预示早期复发和不良预后.     

Massive congenital intracranial teratoma diagnosed in utero

The authors describe a case of congenital intracranial teratoma. The patient was diagnosed to be hydrocephalic at 29 weeks' gestation, and to have a huge intraventricular mass lesion at 34 weeks' gestation. Subsequently, the patient underwent subtotal resection of the mass, resulting in a significant decrease in the remarkably elevated alpha-fetoprotein in serum and cerebrospinal fluid. Histological analysis revealed a malignant teratoma, also with alpha-fetoprotein-positive elements in the immunohistochemical study.     

TSGF、AFP联合检测对原发性肝癌诊断意义的评估

目的　测定 4 5例原发性肝细胞癌 (PHC)患者血清恶性肿瘤特异性生长因子 (TSGF)和甲胎蛋白(AFP)水平 ,探讨其对原发性肝细胞癌的临床诊断价值。方法　对 4 5例PHC患者和 2 5例良性肝病患者进行TSGF和AFP测定 ,并与健康对照组进行比较。结果　PHC患者TSGF含量明显增高 ,与良性肝病组和健康对照组比较差异显著 (P <0 .0 1) ,良性肝病组与健康对照组比较TSGF含量无明显差异 (P >0 .0 5 )。结论　PHC患者血清TSGF水平明显增高 ,血清TSGF和AFP联合检测能有效提高PHC的检出率     

Early prognostic biochemical indicators of fulminant hepatic failure

We investigated whether prognostic factors could be used for selecting appropriate therapy in patients with fulminant hepatic failure, for which orthotopic liver transplantation is often considered necessary. As, however, some patients survive without transplantation, a method is required to enable early distinction between patients requiring immediate transplantation and those who would survive without transplantation. As a number of prognostic indicators proposed for the identification of patient types are not completely satisfactory, in this retrospective study we investigated whether laboratory tests to evaluate severity of illness are best performed on the day of the appearance of the transaminase peak or the day of admission. The study included 44 patients with acute non-acetaminophen-induced liver failure. All patients received the same supportive care. Fourteen (group A) survived without transplantation and 20 (group B) died during hospitalization. Ten patients were excluded either because they underwent liver transplantation or data were incomplete. We studied prothrombin times and alpha-fetoprotein levels; values increased in the group of survivors throughout the period of illness, whereas they were low in patients who died. Both parameters allowed differentiation between patients of the two groups as from the 1st day after peak (P<0.05). The method proposed allows us to improve the predictive capacity of these laboratory tests in fulminant hepatic failure at an early stage of disease and to make an early selection of candidates for liver transplantation.     

Correlation and prognostic significance of beta-galactoside alpha-2,6-sialyltransferase and serum monosialylated alpha-fetoprotein in hepatocellular carcinoma

AIM: To investigate the correlation between tissue ST6Gal Ⅰ and serum msAFP in HCC patients, and to investigate their prognostic significance. METHODS: Preoperative sera, paired tumorous and non-tumorous tissues were collected from 19 consecutive patients who had undergone surgical resection of HCC. ST6Gal Ⅰ activities in the tissues were measured by an in vitro microsomal enzyme activity assay. The percentages of tumor-specific msAFP in the sera were also estimated by an isoelectric focusing-immunoblotting assay. RESULTS: The tumor ST6Gal Ⅰ activity was negatively correlated with serum msAFP percentage (r = -0.53, P = 0.019). Both decreased tumor ST6Gal Ⅰ activity and increased serum msAFP percentage were associated with poor tumor cell differentiation. Univariate analyses showed that both decreased tumor ST6Gal Ⅰ activity (P = 0.028), increased serum msAFP percentage (P = 0.034) and poor tumor cell differentiation (P = 0.031) were associated with shorter overall survival. Multivariate analysis using the Cox regression model showed that the preoperative serum msAFP percentage (P = 0.022) and tumor cell differentiation status (P = 0.048) were independent prognostic indicators for patient overall survival. CONCLUSION: Our results indicate that the presence of msAFP in blood circulation is associated with a decreased activity of ST6Gal Ⅰ activity in HCC. Both tissue ST6Gal Ⅰ and serum msAFP are potential prognostic markers for patients with operable HCC.     

Stratified alpha-fetoprotein pattern accurately predicts mortality in patients with acute-on-chronic hepatitis B liver failure

Background: Alpha-fetoprotein (AFP) has been shown to predict the prognosis of liver disease in several studies. This study aimed to evaluate the prognostic value of stratified AFP in patients with acute-on-chronic hepatitis B liver failure (ACHBLF).

Methods: A total of 192 patients were included and AFP were categorized into quartiles. The prognostic value was determined for overall survival (OS) and assessed by Kaplan-Meier analysis. Univariate and multivariate Cox proportional hazard regression analyses studied the association of all independent parameters with disease prognosis.

Results: The optimal cut-off points of AFP were: (Q1) 252.3–4800.0 ng/ml, (Q2) 76.0–252.2 ng/ml, (Q3) 18.6–75.9 ng/ml, and (Q4) 0.7–18.5 ng/ml. Based on the Kaplan-Meier analysis of the OS, each AFP quartile revealed a progressively worse OS and apparent separation (log-rank P = 0.006). The second-highest quartiles of AFP (Q2) always demonstrated an extremely favorable short-term survival. Combining the lowest AFP quartiles with a serum sodium < 131mmol/L or an INR ≥ 3.3 showed a poor outcome (90-days survival of 25.0% and 11.9% respectively).

Conclusions: Stratified AFP could strengthen the predictive power for short-term survival of patients with ACHBLF. Combining AFP quartiles with low serum sodium and high INR may better predict poor outcome in ACHBLF patients.