Analysis On The Correlation Of α-fetoprotein With Liver Disease

Alpha-fetoprotein is the main component of fetal serum proteins, which ceases to be produced right after birth.It regains the ability to regenerate in some diseases, such as tumors like hepatocelluar carcinoma, germ cell tumor, rarely seen gastrointestinal tumors and benign liver diseases etc. At present, it has become an important non-invasive qualitative diagnostic method to diagnose tumors written above. It has superiority in early diagnosis of hepatocellular carcinoma, with positive rate of 70-90%.This paper is to discuss in the following aspects. 1. Whether AFP elevation in liver cirrhosis and chronic hepatitis is correlated with aminotransferases (AST, ALT, AST/ALT), the biochemical index signifying liver inflammation. 2. According to the newest TNM staging and grading (AJCC 2003), tumors with the same prognosis fall into the same group, thus in this paper we analyze whether AFP value is correlated with T stage, and whether there is difference between the proportion of patients with different prognosis in AFP-positive liver cancer and that of AFP-negative one.PATIENTS and METHODS: Patients with liver disease admitted to our hospital from November 2003 to February 2007 were chosen. 1, 276 liver cirrhosis, 140 chronic hepatitis: Calculated the positive rate of two groups, and analyzed separately the correlation of AFP valuewith aminotransferases (AST, ALT, AST/ALT). 2, 125 cases of hepatoma (AFP-positive 79 cases, AFP-negative 46 cases): Grouped them into different T, and analyzed the difference of AFP value among the groups in AFP-positive cases, and the correlation of AFP level with T stage.RESULTS: 1. In liver cirrhosis group, 86 patients (30.1%) showed AFP elevation ranging from 21.1ng/ml to 3000.0ng/ml, 81.9% of which were HBV infected, followed by HCV infection (15.7%). In chronic hepatitis group, AFP positive rate was 38.6% (54 cases in total) AFP ranged from 20.7ng/ml to 2662.5ng/ml in the 54 cases, with HBV infection (83.3%) being the predominant factor, also followed by HCV infection (5.6%). The odds ratio of HBV in both groups was higher than 1 in univariate analysis on the factors that may cause AFP elevation, which means that HBV infection is related with AFP elevation. 2. Alcoholic liver hepatitis without viral infection or other factors showed no elevation in AFP level in two groups. According to the documents, AFP positive rate in alcoholic liver disease varied significantly (0-27%). The reasons for variation might be as follows: different patient sources, different liver inflammation states caused by alcoholic intoxication and probably distinct alcohol consumption on the admission day. Ethanol might decrease serum AFP level. Besides, the odds ratio of alcohol in both groups is lower then 1 in univariate analysis on the factors that may cause AFP elevation, which meansthat alcohol is not related with AFP elevation. 3, In cirrhosis group, AFP level was moderately correlated with ALT (r=-0.245, p<0.05), while in hepatitis group, it was moderately correlated with AST/ALT ratio (r=-0.278, p<0.01). Increase of AFP level signifies active hepatic regeneration. When the extent and velocity exceeds destruction of hepatocytes, the level of transaminases might show decrease, and liver inflammation is lightened. 3, In 79 cases of AFP-positive hepatoma, AFP level in T3 group (multiple tumors with maximum diameter exceeding 5cm, or invasion of portal and hepatic vein) was higher than that of T1 group (isolated tumor without vessel invasion). 5. AFP level was mildly correlated with T staging (r=0.279, p<0.01). 6. There was difference between AFP-positive and AFP-negative groups in the percentage of cases which belong to T1, T2 groups and T3, T4 groups. In AFP-positive hepatoma, more patients were with better prognosis. while in AFP-negative hepatoma, patients with worse prognosis took large part.CONCLUSION: It is concluded that AFP elevation is related with virus infection, with HBV being independent risk factor in chronic hepatitis and cirrhosis. In liver cirrhosis AFP value iscorrelated with AST/ALT ratio, while in chronic hepatitis with ALT level. Alcoholic liver disease shows no AFP elevation. AFP level in hepatoma probably affects its prognosis.