慢性乙型肝炎患者血清AFP动态监测临床意义.doc

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1、慢性乙型肝炎患者血清AFP动态监测临床意义【摘要】目的：动态监测慢性乙型肝炎患者血清甲胎蛋白(AFP)变化及肝功能指标，探讨慢性乙型肝炎各模式与AFP定量变化及肝功能改变的关系，高度警惕肝癌的发生。方法：对189例慢性乙型肝炎患者同时用ELISA法进行乙型肝炎五项血清学标志物、用RIA法进行AFP检测和谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷胺酰转肽酶(GGT)和碱性磷酸酶(ALP)的水平检测。AFP升高者分别作B超、CT检查,排除肝癌后每2个月复查1次AFP、肝功、B超,连续进行2a~5a追踪随访。结果：189例中146例AFP不同程度和不同类型

2、升高。随访中HBsAg、抗HBe及抗HBc3项阳性(即“小三阳”)中发现AFP稳定上升型的11例(15.5%)均发展为肝癌；HBsAg、HBeAg及抗HBc3项阳性即“大三阳”中发现AFP稳定上升型的3例(4.8%)发展为肝癌；HBsAg、抗HBc2项阳性组中1例AFP稳定上升型发展为肝癌。一过性升高和一直未升高型均未出现肝癌。结论：慢性乙型肝炎小三阳感染模式动态监测AFP变化,对早期发现肝癌有重要价值。【关键词】慢性乙型肝炎；AFP；肝癌　　ClinicalSignificanceofDynamicObservationonSerumAFPin

3、PatientswithChronicHepatitisBVirus　Abstract：ObjectiveMonitoringdynamiclevelofserumAFPandtheirmarkerofliverfunction,todiscusstherelationshipbetweenHBVinfectionmodesandAFPchangelevelandliverfunctioninpatientswithchronichepatitisBvirus,andfindthediagnosticvalueaboutprimaryhepatocell

4、ularcarcinoma.MethodsHBVinfectionmodesaredetectedbyELISAandAFPbyRIAandALT,AST,GGT,ALPbybiochemicalassaysimultaneityin189patientswithchronichepatitisBvirus.Btypeultrasonicandcomputerizedtomography(CT)wereconductedonthosewhoseAFPrisewasfoundforthefirsttimesoastoexcludelivercancer,a

5、ndthentheyweretestedonhepaticfunctionandretestedonAFPandBtypeultrasoniceverytwomonthsandwerefollowedupsuccessivelyuptotwoandfiveyears.ResultsOfthe189hepatitisBvirusinfectionchildrenpatients,146riseddissimilarlyindegreeandtypeaboutAFPlevel.Accordingtothefollowup,11caseswhoseAFPl

6、evelkeptrisingsteadilywithHBsAg、antiHBeandantiHBcpositivemodelsand3casewhosewhoseAFPlevelkeptrisingsteadilywithHBsAg、HBeAgandantiHBcpositivemodelsallbecameprimaryhepatocellularcarcinoma.ButNolivercancerwasfoundamongthosewhoseAFPlevelrisedephemerallyandwhoseAFPlevelneverrised.C

7、onclusionItisvaluableforchronichepatitisBviruspatientswithHBsAg、antiHBeandantiHBcpositivemodelstodynamiciallyobserveon4itsAFPlevel,theymayfindprimaryhepatocellularcarcinomaearlier.Keywords：ChronichepatitisBvirus;AFP;Hepatocellularcarcinoma甲胎蛋白(AFP)主要是由胚胎肝细胞、卵黄囊和胃肠上皮细胞产生的一种特殊球蛋白。

8、健康成年人血清AFP水平小于20ng/ml，1964年Tatarinov发现原发