AFP和AFU预测原发性肝癌肝移植术后复发的价值.doc

文档介绍：AFP和AFU预测原发性肝癌肝移植术后复发的价值
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【摘要】目的:探讨甲胎蛋白(AFP)和α-L-岩藻糖苷酶(AFU)预测肝癌肝移植术后复发的价值。方法:对35例肝癌肝移植患者术后进行随访和观察。记录复发时血清中AFP和AFU的变化,进行总结和分析。并与同期住院的非肝病患者21例和健康人10例进行对照。结果:随访时间2~12月,平均(±)个月,失访10例,25例患者全部复发,肝内复发12例(48%),肝外13例(肺36%,骨4%,门脉癌栓4%,多发转移8%)。肝内复发组AFU呈明显上升趋势,肝外复发组复发前后AFU变化趋势不明显,而肝内复发组和肝外复发组AFP呈散在变化。结论:AFP对肝癌肝移植术后肝内复发的敏感性和特异性低于AFU,AFU是肝癌肝移植术后随访的较好的血清学指标。
【关键词】甲胎蛋白类·α-L-岩藻糖苷酶·复发·肝肿瘤·肝移植
【ABSTRACT】 Objective: To approach the prediction value of alpha-fetoprotein(AFP) and α-L-fucosidase(AFU) during the hepatoma recurrence post of liver transplantation. Methods: Thirty-five patients with hepatoma recurrence underwent transplantation of liver were followed up and observed. The changes of AFP and AFU i
n blood serum during the hepatoma recurrence post-transplantation of liver were analyzed. Results: It was followed up 2 to 12 months, 10 patients were lost. The average time was(±) months. The rest 25 patients were all suffered hepatoma recurrence. There were 12 in liver recurrence(48%), 13 recurrence outside(lung 36%, bone 4%, portal vein cancer blot 4%, crinosity transfusion 8%). Conclusion: The sensitivity and specificity of AFU is better than AFP in the hepatoma recurrence, AFU is a better blood serum index in following up the hepatoma recurrence post liver transplantation.
【KEY WORDS】 Alpha-fetoproteins·Alpha-L-fucosidase·Recurrence·Liver neoplasm·Liver transplantation
肝移植是治疗肝癌的较为有效的手段,但术后复发和转移严重影响其疗效。目前对移植后肿瘤复发的诊断,主要依靠影像学,费用昂贵,并且明确诊断时肿瘤已经到了晚期。血液中是否有表达更早、更加敏感和特异的肿瘤标志物,目前国内外报道较少。我们对肝癌肝移植后的患者35例进行随访,观察肿瘤复发时血清中甲胎蛋白(
α-fetoprotein,AFP)和α-L-岩藻糖苷酶(α-L-fucosidase,AFU)的变化,进行总结和分析。
1 资料与方法
一般资料
2006年3月—2007年12月,收集行肝癌肝移植患者35例(中国人民解放军第二炮兵总医院23例,北京大学人民医院9例,解放军302医院3例),25例获随访。男21例,女4例,年龄34~64岁,平均年龄(±)岁。其中24例有乙型病毒性肝炎相关病史,1例有酒精性肝硬化病史。术前HBsAg阳性19例,阴性6例。2例患者移植术前有肝癌切除史。6例术前肿瘤直径<5 cm,其余为5~17 cm。肝功能分级:Child A级20例,B级1例,C级4例。术前AFP阳性14例,阴性11例。术后病理组织学检查:肝癌中分化13例(合并血管癌栓4例),高分化2例,其余10例为低分化和未分化。供肝灌注和保存均采用UW液,手术采用背驮式12