肿瘤相关抗原联合动态监测在原发性肝癌诊疗中的临床应用

摘要

目的：探讨血清肿瘤相关抗原甲胎蛋白（AFP）、糖类抗原199（CA199）、转化生长因子β1（TGF-β1）和磷脂酰肌醇蛋白聚糖3（GPC3）联合动态监测在原发性肝癌早期诊断和监控治疗中的临床应用价值。方法：选取92例原发性肝癌患者（恶性肿瘤组）、50例肝脏良性病变患者（良性对照组）及50例健康体检者（正常对照组）为研究对象，采用电化学发光法检测其血清AFP、CA199，酶联免疫法检测血清TGF-β1、GPC3水平，采用回顾性统计方法对各指标表达情况进行比较分析。结果：原发性肝癌患者血清AFP、CA199、TGF-β1、GPC3水平显著高于良性对照组和正常对照组（P<0.01）；原发性肝癌患者血清AFP、CA199、TGF-β1、GPC3水平与肿瘤分化程度、临床分期、有无肝内转移、癌栓、液化坏死、复发及治疗后相关；AFP、CA199、TGF-β1、GPC3诊断原发性肝癌的敏感性分别为58.70%、53.26%、63.04%、70.65%，特异性分别为92.00%、94.00%、90.00%、90.00%，准确性分别为70.42%、67.61%、72.54%、78.87%，四项肿瘤相关抗原联合检测诊断原发性肝癌的敏感性为96.74%，准确性为92.31%，与各单项检测比较明显提高，差异有统计学意义，（P<0.05），特异性有所降低，为86.00%。结论：联合检测血清AFP、CA199、TGF-β1及GPC3可提高原发性肝癌检出率，同时可预测肿瘤分化程度、临床分期、癌栓、液化坏死、转移及复发，并对治疗后随访具有指导意义。%Objective:To investigate the significance the dynamic multi-detection of alpha fetoprotein(AFP),carbohydrate antigen 199(CA199),transforming growth factor beta 1(TGF-β1) and glypican-3(GPC-3) in eary dignosis and treatment of primary liver cancer. Methods:92 patients with primary liver cancer (malignant group),50patients with benign liver diseases (benign group) and 50 healthy persons (normal controls ) were included in this research. Serum AFP,CA199 levels were detected by electrochemiluminescence and TGF-β1,GPC-3 levels were detected by enzyme linked immunosorbent assay in each groups and the datas were then analyzed retrospectively.Results:The AFP,CA199,TGF-β1,GPC3 levels in malignant group were significantly higher than those in benign group and normal controls.The high expression of these antigens in malignant group was significantly correlated with differentiation degress,clinical stages,intrahepatic metastasis,cancer embolus,liquefactive necrosis and relapse.The sensibility of AFP,CA199,TGF-β1 and GPC-1 in dignosis of hepatic cancer was 58.70%,53.26%,63.04% and 70.65%,while the specificity was 92.00%,94.00%,90.00%,90.00%and the veracity was 70.42%,67.61%,72.54%,78.87%.The sensibility of multi-detection of these antigens in in dignosis of liver cancer is 96.74%and the veracity is 92.31%,which is significantly higher than the sensibility and veracity of single detection.The specificity of multi-detection is 86.00%,which was lower than single detection. Conclusions:The multi-detection of AFP, CA199, TGF-β1 and GPC-3 can elevate the detection rate of liver cancer and predict the differentiation degress,clinical stages,intrahepatic metastasis,cancer embolus,liquefactive necrosis and relapse of the tumor,which has significant influence on the follow-up visit after treatment.