| Obiective：Hepatocellular carcinoma(HCC) is the second of the world’s malignant tumor,which is the fifth of our country,and morbidity rised year by year in the worldwide.Because of the lack of effective early diagnosis index,most HCC when diagnosic is at the time of middle and late stage,so the prognosis is poor.In recent years,many new serum markers of HCC were found,and is expected to become the earlier idera target for the diagnosis of HCC. AFP is the most common clinical diagnostic serum markers of liver cancer currently,the diagnostic sensitivity between39-64%, specificity between76-91%,but there are still some limitations with AFP in the diagnosis of liver cancer,because serum AFP in quite a lot of liver cirrhosis and viral hepatitis patients also have varying degrees of increase.In addition,AFP also have high degreses in some benign liver diseases,and some malignant tumor in gastrointestinal tract.Moreover,about30%of the HCC in AFP has negative expression,sensitivity is not high.The false negative rate of AFP could reach more than40%in early HCC,advanced liver cancer AFP false negative rate was15%-20%,which influenced the diagnosis of clinical practicability to a certain extent. GP73is gorky Ⅱ transmembrane protein,which easy to N-amino end glycosylation,is mainly expressed in multiple tissues of human epithelial cells.GP73is mainly expressed in the bile duct epithelial cells of portal area in the normal liver,which is almost no expression in liver cells.When severe acute hepatitis or liver fibrosis,GP73expression in liver cells increases obviously,the expression of GP73is further improved which in liver cirrhosis,and the expression of peak in HCC.Vimentin is a kind of important type III silk protein in the middle,which is mainly expressed in embryonic and from mesenchymal tissue sources of adult cells. A study shows used cDNA array and immunohistochemical method to find that waveform fibrous protein in liver cancer cells and liver tissue in expression,they think the waveform fibrin and metastatic liver cancer cell has a close relationship.SCCA is a kind of serine protease inhibitors,which exist in the spine of normal squamous epithelial layer and granular layer,but its typical expression in tumor cells of epithelial origin.SCCA-IgM as a kind of new serum biomarkers,the sensitivity and specificity were higher,also have higher sensitivity to small metastases,it alone or with AFP,joint application can greatly improve the sensitivity and specificity of HCC diagnosis.This study is for HBV related HCC patients as the research object,people with liver cirrhosis after hepatitis b and healthy control, respectively to detect the serum AFP,GP73,Vimentin,SCCA-IgM level,analysis on the determination results,at the same time observe the four tumor markers single item and the value of combined detection of HCC diagnosis.Currently,there was no serum markers of higher sensitivity and specificity for early diagnosis of HCC in clinical,so we need to discover new serum indexes in order to improve the diagnosis of HCC.Mathods:By detecting the level of serum AFP,GP73,imetin and SCCA-IgM from57HCC patients (early HCC,n=23;advanced HCC,n=34),67chronic HBV infected control patients (immune tolerant phase,n=21;immune clearance phase, n=21;HBV-related liver cirrhosis,n=25),as well as15healthy control,AFP detect by immune chemiluminescence detection,GP73,Vimentin and SCCA-IgM detect by ELISA,to compare the sensitivity and specificity of four serum markers in the diagnosis of early HCC.Results:Serum AFP,GP73,Vimentin and SCCA-IgM level were higher in advanced HCC patients than in early HCC patients,but without statistical significance was observed(P>0.05).Serum AFP,Vimentin and GP73level were significantly higher than the control group whether in early HCC group or in advanced HCC group(p<0.05). Serum SCCA-IgM level was higher in early HCC group than the control group,but without statistical significance was observed(p>0.05),whereas the level was significantly higher in advanced HCC group than the control group(P＜0.05). GP73in liver cirrhosis and immune clearance phase is no statistical significance(P>0.05),liver cirrhosis and immune clearance phase compared with other groups have statistical significance(p<0.05),immune tolerance period compared with healthy people with no statistical significance(p>0.05).The ROC curve showed that the area under ROC curve (0.853), the specificity (87.8%), the sensitivity (73.7%) and the diagnostic rate of HCC (73.7%) of serum SCCA-IgM IC were maximum. GP73and SCCA-IgM IC were both positive showed the higher sensitivity (61.40%) and specificity (91.46%).Conclusion:The results suggested that anyone of serum AFP, GP73, Vimentin and SCCA-IgM showed no particularity in the diagnosis of early HCC, however the combination of serum markers may improve the diagnosic rate of early HCC. |
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