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目的 探讨肝癌患者外周血癌细胞表达AFPmRNA的临床意义。方法 采用NestedRT PCR检测外周血中癌细胞表达的AFPmRNA。结果 原发性肝癌患者 45例 ,AFPmRNA阳性率76 % (34 / 45 )。 17例继发性肝癌患者 ,原发癌来自结肠癌 7例、直肠癌 5例、胆囊癌 2例 ,小肠平滑肌肉瘤 2例、乳腺癌 1例。AFPmRNA阳性率 6 5 % (11/ 17)。原发性肝癌患者AFPmRNA阳性率在AFP大于 2 0 μg/L组 90 % (2 6 / 2 9)、有肝外转移组 94% (16 / 17)、TNM分期Ⅳ期组 88% (2 3/ 2 6 )分别高于AFP小于 2 0 μg/L组 5 0 % (8/ 16 )、未发现肝外转移组 6 4% (18/ 2 8)和TNM分期Ⅱ期组 46 % (6 / 13) (P <0 0 5 ,P <0 0 1)。继发性肝癌患者AFPmRNA阳性率在肝外肿瘤存在组 90 % (9/ 10 )较肝外无肿瘤组(原发病灶切除 ) 2 8 6 % (2 / 7)为高 (P =0 0 36 )。结论 检测肝癌患者外周血中有核细胞表达AFPmRNA较血清AFP更敏感 ,可作为肝癌的诊断、恶性肿瘤分期和有无肝外转移及愈后的指标。
Objective To investigate the clinical significance of AFP mRNA expression in peripheral blood of patients with liver cancer. Methods Nested RT PCR was used to detect AFP mRNA expression in cancer cells in peripheral blood. Results 45 cases of primary liver cancer patients, AFPmRNA positive rate of 76% (34/45). 17 cases of secondary liver cancer patients, primary cancer from colon cancer in 7 cases, 5 cases of rectal cancer, gallbladder cancer in 2 cases, 2 cases of small bowel leiomyosarcoma, 1 case of breast cancer. The positive rate of AFP mRNA was 65% (11/17). The positive rate of AFP mRNA in patients with primary liver cancer was 90% (26/29) with AFP greater than 20 μg / L, 94% (16/17) with extrahepatic metastasis, 88% (23% / 2 6) were higher than 50% (8/16) in AFP less than 20 μg / L group, 46% (18/2 8) in extrahepatic metastasis group and 46% (6 / 13) (P <0 05, P <0 01). The positive rate of AFP mRNA in patients with secondary liver cancer was higher than that in extrahepatic non-tumor group (28%) (2/7) in the extrahepatic group (P <0.05) ). Conclusion Detection of AFP mRNA expression in peripheral blood mononuclear cells in patients with hepatocellular carcinoma is more sensitive than serum AFP, which can be used as a diagnosis of liver cancer, staging of malignant tumor, and extrahepatic metastasis and prognosis.