慢性乙型肝炎患者血清AFP动态监测临床意义

目的:动态监测慢性乙型肝炎患者血清甲胎蛋白(AFP)变化及肝功能指标,探讨慢性乙型肝炎各模式与AFP定量变化及肝功能改变的关系,高度警惕肝癌的发生。方法:对189例慢性乙型肝炎患者同时用ELISA法进行乙型肝炎五项血清学标志物、用RIA法进行AFP检测和谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷胺酰转肽酶(GGT)和碱性磷酸酶(ALP)的水平检测。AFP升高者分别作B超、CT检查,排除肝癌后每2个月复查1次AFP、肝功、B超,连续进行2a~5a追踪随访。结果:189例中146例AFP不同程度和不同类型升高。随访中HBsAg、抗-HBe及抗-HBc3项阳性(即"小三阳")中发现AFP稳定上升型的11例(15.5%)均发展为肝癌;HBsAg、HBeAg及抗-HBc3项阳性即"大三阳"中发现AFP稳定上升型的3例(4.8%)发展为肝癌;HBsAg、抗-HBc2项阳性组中1例AFP稳定上升型发展为肝癌。一过性升高和一直未升高型均未出现肝癌。结论:慢性乙型肝炎小三阳感染模式动态监测AFP变化,对早期发现肝癌有重要价值。

Clinical Significance of Dynamic Observation on Serum AFP in Patients with Chronic Hepatitis B Virus

Objective Monitoring dynamic level of serum AFP and their marker of liver function, to discuss the relationship between HBV infection modes and AFP change level and liver function in patients with chronic hepatitis B virus, and find the diagnostic value about primary hepatocellular carcinoma. Methods HBV infection modes are detected by ELISA and AFP by RIA and ALT, AST, GGT, ALP by biochemicalassay simultaneity in 189 patients with chronic hepatitis B virus. B type ultrasonic and computerized tomography (CT) were conducted on those whose AFP rise was found for the first time so as to exclude liver cancer, and then they were tested on hepatic function and re-tested on AFP and B type ultrasonic every two months and were followed up successively up to two and five years. Results Of the 189 hepatitis B virus infection children patients, 146 rised dissimilarly in degree and type about AFP level. According to the follow-up, 11 cases whose AFP level kept rising steadily with HBsAg、anti-HBe and anti-HBc positive modelsand3 case whose whose AFP level keptrisingsteadily with HBsAg、HBeAg and anti- HBc positivemodels all became primary hepatocellular carcinoma.But No liver cancer was found among those whose AFP level rised ephemerally and whose AFP level never rised. Conclusion It is valuable for chronic hepatitis B virus patients with HBsAg、anti-HBe and anti HBc positive models to dynamicially observe on its AFP level, they may find primary hepatocellular carcinoma earlier.