甲胎蛋白异质体在原发性肝癌临床诊断中的应用

目的 通过临床大样本数据回顾性分析血清甲胎蛋白（AFP）和甲胎蛋白异质体（AFP-L3）诊断原发性肝癌（PLC）的价值。方法 2015年1月～2015年12月东方肝胆外科医院诊治的PLC患者7097例，同期诊治的肝硬化（LC）患者122例。采用化学发光法检测血清AFP水平，采用凝集素捕获微量离心柱法检测AFP-L3，将AFP-L3/AFP比值大于10%定义为AFP-L3阳性。结果 7097例PLC患者血清AFP水平为61.7（5.4，1226.0）μg/L，显著高于122例LC患者的3.6（2.5,10.95） μg/L（P<0.05），AFP-L3阳性率为8.2（-，26.1）%，而在肝硬化患者未检出AFP-L3阳性（P<0.05）；以血清AFP≥20 μg/L或/和AFP-L3≥10%任一阳性为截断点，诊断PLC的准确度为63.1%，优于AFP（60.3%）和AFP-L3（47.9%）单独诊断的结果；AFP-L3阳性率随着AFP水平的升高而升高；血清AFP阴性的PLC和AFP阳性的LC患者AFP-L3阳性率分别为39.6%和7.7%，显著低于血清AFP阳性PLC患者的73.7%（P<0.05）；在2103例具有病理学诊断的PLC患者，1976例肝细胞癌（HCC）患者血清AFP水平为50.8（4.8，1015.0） μg/L，6例混合型肝癌患者血清AFP水平为74.9（4.55，39248.3） μg/L，AFP-L3阳性率分别为5.3（-，24.6）%和8.4（-，18.8）%，均显著高于121例肝内胆管细胞癌患者【2.8（2.2，5.15） μg/L，P<0.05】和【-（-，-）%，P<0.05】。结论 大样本的结果显示PLC患者血清AFP和AFP-L3存在较高的阳性率，其诊断效能较好。

Diagnostic value of serum alpha-fetoprotein and lentil lectin-reactive alpha-fetoprotein in patients with primary liver cancer

Objective To retrospectively analyze serum alpha-fetoprotein（AFP） and lentil lectin-reactive alpha-fetoprotein ratio（AFP-L3%） in the diagnosis of patients with primary liver cancer （PLC）. Methods A cohort of 7097 patients with PLC was recruited in Eastern Hepatobiliary Surgery Hospital between January 2015 and December 2015. At the same period，122 patients with liver cirrhosis（LC） were enrolled. Serum AFP and AFP-L3 were detected by electrochemiluminescence and lectin microcentrifugalcolunm，respectively. The positivity of AFP-L3 was defined as the ratio of AFP to L3/AFP was higher than 10%. Results Serum AFP level in 7097 patients with PLC was 61.7（5.4，1226.0） μg/L，much higher than 3.6（2.5，10.95） μg/L（P<0.05） in 122 patients with LC，and the AFP-L3 positivity was 8.2（-，26.1）%，significantly higher than in patients with LC as all were negative in the latter（P<0.05）；the accuracy in diagnosis of PLC was 63.1%，higher than 60.3% by serum AFP or 47.9% by AFP-L3 alone when either of serum AFP≥20μg/L and/or AFP-L3≥10% as the cut-off-value； the positivity of AFP-L3 increased as serum AFP levels increased；the positivity of AFP-L3 in PLC patients with negative serum AFP and in LC patients with positive serum AFP were 39.6% and 7.7%，respectively，both significantly lower than 73.7%（P<0.05） in PLC patients with positive AFP；serum AFP levels and positivities of AFP-L3 were 50.8（4.8，1015.0） μg/L and 5.3（-，24.6）% in 1976 patients with histology-proven hepatocellular carcinoma（HCC），and 74.9（4.55，39248.3）μg/L and 8.4（-，18.8）% in 6 patients with histology-proven mixed hepatoma，both higher than 【2.8（2.2，5.15）μg/L，P<0.05】 and 【-（-，-）%，P<0.05】 in 121 patients with histologically diagnosed intrahepatic cholangiocarcinoma. Conclusion Our big data confirm again AFP and AFP-L3 have a higher positive rate in PLC，and its diagnostic value is good.