The Value of Combined Serum Alpha-fetoprotein Heteroplasmon-L3 Concentration and AFP-L3/Alpha-fetoprotein Ratio Detection in the Early Diagnosis of Primary Liver Cancer_West China Medical Journal

Authors：

1. Department of Nuclear Medicine Laboratory, The People’s Hospital of Tangshan, Hebei Union University, Tangshan, Hebei 063000, P. R. China; 2. Department of Clinical Laboratory, The Leting County Hospital, Tangshan, Hebei 063000, P. R. China;

Corresponding?author：

Keywords：

甲胎蛋白; 甲胎蛋白異質體; 聯合檢測; 肝細胞癌; 診斷; 酶聯免疫吸附實驗; 微量吸附柱法

DOI：

10.7507/1002-0179.20130225

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目的　通過檢測肝病患者血清甲胎蛋白異質體（AFP-L3）濃度和AFP-L3/血清甲胎蛋白（AFP）比值，分析探討并聯運用兩指標在肝細胞癌（HCC）診斷中的價值。方法　選取2011年3月－11月137例的住院患者血清標本，AFP檢測均為陽性。依據病理學診斷，將137例患者分為兩組，HCC組92例，良性肝病組45例，后者包括肝硬化結節37例、慢性活動性肝炎8例。采用酶聯免疫吸附試驗（ELISA）檢測所有患者血清AFP-L3濃度；同時運用微量吸附柱法分離血清中的AFP-L3，采用電化學發光法檢測分離后的AFP-L3和血清中總AFP濃度，計算AFP-L3/AFP比值。計算采用AFP-L3濃度與AFP-L3/AFP比值以及AFP-L3濃度與AFP-L3/AFP比值兩指標并聯診斷HCC的靈敏度、特異度、Youden指數等統計學指標，探討其在原發性肝癌診斷中的價值。結果　① HCC組 AFP-L3濃度（109.04 ± 62.51）ng/mL，明顯高于良性肝病組（25.96 ± 49.43）ng/mL，差異有統計學意義（t=8.28，P＜0.001）。HCC組血清AFP-L3/AFP比值（17.35 ± 14.48%）高于良性肝病組（5.617 ± 6.38%）, 差異有統計學意義（t=6.545，P＜0.0001）。② 以血清AFP-L3濃度＞38.0 ng/mL作為臨界值診斷原發性肝癌的靈敏度為83.69%，特異度為88.88%，以AFP-L3/AFP比值＞10%作為臨界值診斷原發性肝癌的靈敏度為83.69%，特異度為95.55%。③ 并聯應用血清AFP-L3濃度＞38.0 ng/mL、AFP-L3/AFP＞比值7.5%診斷HCC的靈敏度為97.83%，特異度為84.44%。結論　并聯應運AFP-L3濃度與AFP-L3/AFP比值診斷HCC較應用單一指標診斷特異度稍有下降，但明顯提高了診斷的靈敏度，更有利于HCC的早期診斷。

Citation： HUANG Caiyun,HAN Sugui,JIA Honglian.. The Value of Combined Serum Alpha-fetoprotein Heteroplasmon-L3 Concentration and AFP-L3/Alpha-fetoprotein Ratio Detection in the Early Diagnosis of Primary Liver Cancer. West China Medical Journal, 2013, 28(5): 724-727. doi: 10.7507/1002-0179.20130225 Copy

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12.	Yoshida S, Kurokohchi K, Arima K, et al. Clinical significance of len culinaris aggluntinin-reactive fraction of serum alpha- fetoprotein in patients with hepatocellular carcinoma[J]. Int J Oncol, 2002, 20(2): 305-309.
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1. 　青柳豊. 腫瘤標志物的臨床診斷意義及展望——甲胎蛋白(AFP)L3組分[J]. 日本醫學介紹, 2005, 26(2): 49-50.
2. 　El-Serag HB, Marrero JA, Rudolph L, et al. Diagnosis and treatment of hepatocellular carcinoma[J]. Gastroenterology, 2008, 134(6): 1752-1763.
3. 　Gupta S, Bent S, Kohlwes J. Test with hepatitis C: a systematic review and critical analysis[J]. Ann Intern Med, 2003, 139(1): 46-50.
4. 　Wu W,Yao DF, Qiu LW, et al. Quantitative analysis of hepatoma-specific a-fetoprotein (HS-AFP) by a new mini-column affinity chromatography and its clinical value in diagnosis of hepatocellular carcinoma[J] . Chin-Ger J Clin Oncol, 2008, 7(3): 131-134.
5. 　Li D, Mallory T. AFP-L3: a new generation of tumor marker for hepatocellular carcinoma[J]. Clin Chim Acta, 2001, 313(1-2): 15-19.
6. 　中華醫學會傳染病與寄生蟲病學分會和肝病學分會. 病毒性肝炎防治方案[J]. 中華肝臟病雜志, 2000, 12(5): 257-261.
7. 　中國抗癌協會. 新編常見惡性腫瘤診治規范(原發性肝癌分冊)[M]. 北京:北京醫科大學與中國協和醫科大學聯合出版社, 1999: 22-23.
8. 　張雯, 錢金雄, 肖彥革, 等. 甲胎蛋白異質體(AFP- L3)檢測技術的研究進展[J]. 分子診斷與治療雜志, 2009, 1(3): 213-216.
9. 　陳敏,王永忠,杭雙榮,等.甲胎蛋白異質體對肝細胞癌的預測作用[J]. 新醫學, 2009, 40(8): 514-515.
10. 　Fujiyama S, Tanaka M, Maeda S, et al. Tumor markers in early diagnosis , follow2up and management of patient s with hepatocellular carcinoma[J]. Oncology, 2002, 62 (Suppl 1) : 57-63.
11. 　Chu CW , Hwang SJ , Luo JC, et al. Clinical, virologic,and pat hologic significance of elevated serum alpha2fetoprotein levels in patient s wit h chronic hepatitis C[J]. J Clin Gast roenterol, 2001, 32 (3): 240-244.
12. 　Yoshida S, Kurokohchi K, Arima K, et al. Clinical significance of len culinaris aggluntinin-reactive fraction of serum alpha- fetoprotein in patients with hepatocellular carcinoma[J]. Int J Oncol, 2002, 20(2): 305-309.
13. 　黃彩云, 韓素桂, 張景華, 等. ELISA法檢測甲胎蛋白異質體用于肝癌診斷的探討[J].標記免疫分析與臨床, 2012, 19(3): 147-149.
14. 　黃彩云, 韓素桂, 張景華, 等. 酶聯免疫吸附法和凝集素微量離心柱法檢測甲胎蛋白異質體的研究[J]. 現代腫瘤醫學, 2012, 20(12): 2574-2576.
15. 　Leerapu A, Suravarapu SV , Bida JP, et al. The utility of Lensculinaris agglutinin-reaclive alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: evaluation in a United States referral population[J]. Clin Gastroenterol Hepatol, 2007, 5(3): 394-402.

West China Medical Journal

The Value of Combined Serum Alpha-fetoprotein Heteroplasmon-L3 Concentration and AFP-L3/Alpha-fetoprotein Ratio Detection in the Early Diagnosis of Primary Liver Cancer

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