EARLY RECOGNITION OF HEPATOCELLULAR-CARCINOMA BASED ON ALTERED PROFILES OF ALPHA-FETOPROTEIN
EARLY RECOGNITION OF HEPATOCELLULAR-CARCINOMA BASED ON ALTERED PROFILES OF ALPHA-FETOPROTEIN
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DOI：
10.1056/nejm199306243282502
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发表时间：
1993-06-24
影响因子：
158.5
通讯作者：
NAGATAKI, S
中科院分区：
文献类型：
--
作者：
SATO, Y;NAKATA, K;NAGATAKI, S
背景肝细胞癌患者循环甲胎蛋白的糖链结构与肝硬化患者不同。我们研究了甲胎蛋白与两种凝集素，透镜culinaris凝集素A和红细胞凝集植物血凝素的反应性，以监测肝细胞癌患者的进展。在361名主要由慢性乙型肝炎B或丙型肝炎病毒感染引起的肝硬化患者中，在平均35个月的随访期间，发现33名基线血清甲胎蛋白浓度大于或等于30 ng/ml的患者患有肝细胞癌。对这33例患者血清中甲胎蛋白的凝集素反应谱进行分析，并与32例基线血清甲胎蛋白浓度升高的肝硬化患者血清中的凝集素反应谱进行比较，这些患者随访至少24个月，但未发生肝细胞癌。在肿瘤检测时，33例肝硬化和肝细胞癌患者中有24例（73%）的L。与32例肝硬化但无肝细胞癌的患者相比，32例肝硬化患者的红细胞凝集素A反应性甲胎蛋白（甲胎蛋白L3）、红细胞凝集素植物凝集素反应性甲胎蛋白（甲胎蛋白P4+P5）或两者均存在。在24例患者中，在通过成像技术检测到肝细胞癌之前3至18个月，一种或两种标志物首次升高。在某些情况下，血清甲胎蛋白的甲胎蛋白L3和甲胎蛋白P4+P5组分的测量允许肝细胞癌与肝硬化的区分，并作为肝硬化患者随访期间肝细胞癌发展的预测标志物。
Background. The sugar-chain structures of circulating alpha-fetoprotein in patients with hepatocellular carcinomas differ from those in patients with cirrhosis. We studied the reactivity of alpha-fetoprotein with two lectins, Lens culinaris agglutinin A and erythroagglutinating phytohemagglutinin, to monitor the evolution of hepatocellular carcinoma in patients with cirrhosis.Methods. Among 361 patients with cirrhosis caused mainly by chronic hepatitis B or hepatitis C virus infection, 33 with base-line serum alpha-fetoprotein concentrations greater-than-or-equal-to 30 ng per milliliter were found to have hepatocellular carcinomas during a mean follow-up of 35 months. The lectin-reactive profiles of the alpha-fetoprotein in the serum of these 33 patients were analyzed and compared with those in the serum of 32 patients with cirrhosis who had increased base-line serum alpha-fetoprotein concentrations and were followed for at least 24 months but in whom hepatocellular carcinoma did not develop.Results. At the time of tumor detection, 24 (73 percent) of the 33 patients with cirrhosis and hepatocellular carcinoma had higher percentages of L. culinaris agglutinin A-reactive alpha-fetoprotein (alpha-fetoprotein L3), erythroagglutinating phytohemagglutinin-reactive alpha-fetoprotein (alpha-fetoprotein P4+P5), or both than the 32 patients with cirrhosis but no hepatocellular carcinoma. Among the 24 patients, one or both of the markers were first elevated 3 to 18 months before the hepatocellular carcinoma was detected by imaging techniques.Conclusions. Measurements of the alpha-fetoprotein L3 and alpha-fetoprotein P4+P5 fractions of serum alpha-fetoprotein allow the differentiation of hepatocellular carcinoma from cirrhosis in some cases and serve as predictive markers for the development of hepatocellular carcinoma during the follow-up of patients with cirrhosis.