甲胎蛋白异质体L3对低浓度甲胎蛋白肝癌诊断的临床意义

目的探讨在低浓度甲胎蛋白（AFP）肝病患者中，甲胎蛋白异质体L3（AFP-L3）的百分含量（AFP—L3％）对肝癌的早期诊断和疗效评估的临床意义。方法收集245例血清低AFP含量（5～40ng／m1）的肝病患者样本（其中肝硬化患者100例、肝癌患者145例），检测AFP—L3％，并对其中100例肝硬化患者和20例肝癌术后患者分别进行3个月和12个月的随访。结果以AFP—L3％≥10％作为阳性判断标准，100例肝硬化患者中阳性为23例，经3个月随访后其中8例诊断为肝癌；145份肝癌患者血清AFP-L3％阳性率为46．2％（67／145）。低浓度AFP肝癌组的AFP—L3％水平显著高于低AFP肝硬化组（t=7．318，P=0．001〈0．01）；20例肝癌患者术后有5例AFP．L3％仍为阳性，其在12个月内的生存率为0，而术后AFP—L3％阴性患者生存概率为15／15。结论AFP—L3％在低浓度AFP肝病患者中对肝癌的早期诊断和术后疗效评估都具有一定的临床意义。

The diagnostic value of hepatocellular carcinoma by AFP-L3 variant determined in AFP low concentrations

Objective To explore the clinical value of alpha-fetoprotein variant （AFP-L3） percentage in the early diagnosis of hepatocellular carcinoma （HCC） and the operation evaluation in the patients with low serum AFP level. Methods AFP-L3 variants from 245 patients （including 100 cases of cirrhosis and 145 cases of HCC） with low serum AFP level（5-40 ng/ml） were isolated and the contents of AFP-L3 variant and total serum AFP were measured to get AFP-L3% （the ratio of AFP-L3 to total AFP）. The follow-up of 3 months for 100 cirrhosis patients and 12 months for 20 HCC patients who underwent operation were performed. Results Using AFP-L3% i〉 10% as a positive criterion, there was a positive rate of 23% with AFP-L3% in 100 cases of cirrhosis, and 8 out of 23 cases of AFP-L3 positive were diagnosed to be HCC after 3 months. There was a positive rate of 46.2% with AFP-L3% in 145 cases of HCC with low serum AFP level. AFP-L3% level was significantly higher in HCC than those in cirrhosis （t = 7. 318,P = 0. 001 〈 0.01 ）. The results of AFP-L3% of 20 HCC patients who underwent operation and therapy showed that the survival rates of AFP-L3% positive eases at 12 months was 0, and the survival rates of AFP-L3% negtive cases at 12 months was 15/15. Conclusion The percentage of AFP-L3 has significant clinical values for the early diagnosis of HCC and the operation evaluation of hepatic resection in the patients with low serum AFP level.