血清AFP水平和组织GPC3、VEGF蛋白表达在丙肝相关肝癌中的意义  

Clinical significance of serum AFP,and tissue GPC3 and VEGF proteins in diagnosis of HCV-associated hepatocellular carcinoma

作　　者：任珊[1] 徐鹏[1] 张莹[2] 任占平[2] REN Shan;XU Peng;ZHANG Ying;REN Zhan-ping(Department of Clinical Laboratory,Li-uzhou People＇s Hospital,Liuzhou 545006,Guangxi,China)

机构地区：[1]柳州市人民医院检验科,广西柳州545006 [2]柳州市人民医院病理科,广西柳州545006

出　　处：《广东医学》2018年第19期2890-2894,共5页Guangdong Medical Journal

基　　金：广西壮族自治区卫生和计划生育委员会科研项目(编号:Z2016121)

摘　　要：目的探讨在慢性丙型肝炎病毒(hepatitis C virus,HCV)感染患者中检测血清甲胎蛋白(alpha fetoprotein,AFP)水平和组织中磷脂酰肌醇蛋白聚糖-3(glypican-3,GPC3)、血管内皮生长因子(vascular endothelial growth factor,VEGF)蛋白表达在丙肝相关肝癌(HCV-related hepatocellular carcinoma,HCV-HCC)中的临床应用价值。方法采用电化学发光分析技术和免疫组化染色技术检测30例慢性丙型肝炎(chromc hepatitis C,CHC)、35例丙肝相关肝硬化(HCV-related liver cirrhosis,HCV-Cirr)、30例HCV-HCC患者和30例对照组血清AFP水平和组织中GPC3、VEGF蛋白的表达,分析评价在慢性HCV感染患者肝脏病变的不同阶段中血清AFP水平变化和组织中GPC3、VEGF蛋白的表达情况。结果血清AFP水平在HCV-HCC组和HCV-Cirr组均显著高于CHC组和对照组(P <0. 05),但HCV-HCC组与HCV-Cirr组之间血清AFP水平差异无统计学意义(P> 0. 05)。GPC3、VEGF蛋白在对照组无阳性表达,在HCV-HCC组的阳性表达率分别为86. 7%(26/30)、76. 7%(23/30),显著高于HCV-Cirr组的31. 4%(11/35)和40. 0%(14/35)(χ~2=20. 10、P <0. 001;χ~2=8. 86、P <0. 05)和CHC组的10. 0%(3/30)、16. 7%(5/30)(χ~2=35. 31、P <0. 001,χ~2=21. 69、P <0. 001),且HCV-Cirr组显著高于CHC组(χ~2=4. 39、P <0. 05,χ~2=4. 25、P <0. 05)。GPC3蛋白在中、低分化肝癌组中的阳性率显著高于高分化组(P <0. 05);而VEGF在高分化组与中、低分化组之间差异无统计学意义(P=0. 120)。HCV-HCC组中10例血清AFP阴性者组织中GPC3、VEGF蛋白阳性表达分别为6例和5例,且两者联合检测的阳性率为70. 0%(7/10); HCV-HCC组中GPC3与VEGF蛋白表达呈正相关(r=0. 479、P=0. 03)。结论 GPC3和VEGF蛋白在HCV-HCC组织中高表达与HCV-HCC的发生、发展有关。在HCV-Cirr患者的持续监测中联合检测血清AFP和组织中GCP3、VEGF蛋白有助于提高临床对HCV-HCC的鉴别水平。Objective To investigate the clinical application value of detection of serum AFP level and tissue GPC3 and VEGF protein expression in the early and differential diagnosis of HCV-related hepatocellular carcinoma in patients with chronic hepatitis C virus infection. Methods Electrochemiluminescence analysis and immunohistochemical staining technique were used to detect serum AFP level and tissue GPC3,VEGF protein in 30 patients with chronic hepatitis C（ CHC）,35 patients with HCV-related cirrhosis（ HCV-Cirr）,30 patients with HCV-related hepatocellular carcinoma（ HCV-HCC） and 30 cases of normal controls. The serum AFP levels and expression of GPC3 and VEGF proteins in different stages of hepatic lesions in patients with CHC were analyzed. Results The expression of GPC3 and VEGF proteins was negative in the control group,but the positive expression rates in the HCV-HCC group were 86. 7%（ 26/30）and 76. 7%（ 23/30）,which were significantly higher than those of HCV-Cirr group（ 31. 4% and 40. 0%,χ^2= 20. 10,P〈0. 001; χ^2= 8. 86,P〈0. 05） and CHC group（ 10. 0% and 16. 7%,χ^2= 35. 31,P〈0. 001; χ^2= 21. 69,P〈0. 001）. And they were significantly higher in HCV-Cirr group than that of CHC group（ χ^2= 4. 39,P〈0. 05; χ^2=4. 25,P〈0. 05）. The positive rate of GPC3 protein in the medium and low differentiation HCV-HCC group were significantly higher than that in the high differentiation group（ P〈0. 05）. The positive expression of tissue GPC3 and VEGF proteins in the 10 cases serum AFP negative in HCV-HCC group were 6 cases and 5 cases,respectively,and the positive rate of the combined detection of GPC3 and VEGF was 70. 0%（ 7/10）. There was a positive correlation between GPC3 and VEGF protein expression in HCV-HCC group（ r = 0. 479,P = 0. 03）. Conclusion The high expression of GPC3 and VEGF protein in HCV-HCC is correlated to the occurrence and development of HCV-HCC. The Combined detection of serum AFP and tissue GCP3 and VEGF protein in the continuous monitoring of HCV-

关 键 词：慢性丙型肝炎 丙肝相关肝硬化 丙肝相关肝癌 磷脂酰肌醇蛋白聚糖-3 血管内皮生长因子 甲胎蛋白 

分 类 号：R735.7[医药卫生—肿瘤] R512.63[医药卫生—临床医学] R730.43