| Background&ObjectiveHepatic carcinoma(HCC） is one of the world’s highly malignant tumor, and theincidence is increasing, especially for the incidence of male which is3times higherthan female. Several diagnostic methods of HCC have been applied toclinic;mainlyincluding the serum tumor markers (the most commonly used for AFP)detection,imaging examination, histologic examination,and mainly liver biopsy.Alpha Fetal Protein (AFP) is the best tumor marker used in diagnosing HCC, but forsome patients who suffered from benign lesions based on the chronic liver diseaseand small liver cancer,the level of AFP is still increased. Traditional imaging is hardto identify cirrhosis nodules from cancer nodules. Clinical studies have shown thatthe routine pathological examination of the liver after liver transplantation can findunexpectedly cancer in a handful of patients with end-stage liver disease, and this ratecan be as high as25%~43%.Currently,although liver cirrhosis and liver cancer are the main indications of liver transplantation, the prognosis are different. The most important problems oftransplantation with liver cancer Are postoprative recurrence and metastasis.Clinically, gradually establishing and improving the early warning system of tumorrecurrence after liver transplantation is very important, which requires the fullpreoperative evaluation.Previous studies have shown that the imbalance of the sexhormone level in the organism can lead to functional and morphological changes ofliver, and it is also reported in some researches that exogenous sex hormones play animportant role in the genesis of benign and malignant tumor. By the means ofmeasuring the level of sex hormone in patients before liver transplantation, we try toexplore the clinical significance of the imbalance of sex hormone in the preoperativeassessment of patients for liver transplantation.Materials&Methods1. General information: to avoid the effect of estrogen, all the subjects involvedin this experiment are male. According to the postoperative pathological diagnosis,among the71recipients in liver transplantation selecteded from those who acceptallograft in situ in the first affiliated hospital of zhengzhou university from September2011to August2013, aging(23-67),35patients suffer from liver cancer,aging(23-57);36cases suffer from liver cirrhosis, aging (29-67), among whom2cases have a preoperative diagnosis of cirrhosis during the liver decompensationperiod, as well as a postoperative pathological diagnosis of HCC. Among thenormal control group are20physically-examined healthy male aged32-64, who haveno history of liver disease, endocrine disease and history of blood transfusion, withnegative result of HBV markers check and normal result of liver function check.Thisstudy has been checked by ethics committee of Zhengzhou university, in line withthe ethics rules.2. Measurement of sex hormone levels: apply before surgery in patients byphlebotomizing venous blood5ml before meal in the morning followed by serumseparation (serum is kept at-80℃for test); serum estradiol (estradiol, E2), testosterone (testosterone, T) and pituitary prolactin (prolactin, PRL) was measuredwith electrochemiluminescence method.3. Statistical methods: using SPSS17.0software for statistical analysis.Measurement data is presented asx±s, and for mean comparison among groups weapply analysis of variance between groups; for the comparison between two groups ofindependent sample we use independent sample t test.Results1.The level of sex hormone and E2/T in the three groups (liver cancer group,cirrhosis of the liver during decompensation period group, control group) is revealedin Chart1.Compared with control group, the level of PRL and E2in the other twogroups were higher, and the difference was statistically significant (P <0.05), but inthe contrast between the liver cancer group and the cirrhosis of the liver duringdecompensation period group,there was no statistically significant difference.Compared with normal control group, T in the group of liver cancer and livercirrhosis have a downward trend, and the difference was statistically significant (P <0.05). Also, difference between the liver cancer group and decompensated cirrhosisgroup was statistically significant (P <0.05).2.For the E2/T ratio, compared with normal control group, the group of livercancer and liver cirrhosis have an upward trend, and the difference was statisticallysignificant (P <0.05), but the liver cancer group increased more obviously, thedifference was statistically significant (P <0.05).3.In the triad of cirrhosis, liver palms and spider are closely with E2levels,higher levels of estrogen, the more likely manifestations of liver palms and spider;while the feminine breast development is closely related with the PRL levels, themore higher PRL levels, the more performance of male breast development inpatients with cirrhosis. Both of the positive and negative groups in the triad ofcirrhosis had significant differences in the E2/T ratio, rather than E2levels.4.With more and more severe of liver function from Child-Pugh A-level toC-level in patients with cirrhosis, the sex hormone levels change more, PRL and E2 levels increased gradually, T levels gradually decreased, E2/T ratio graduallyincreased. PRL and E2levels increased successively from Child A to C grade, thedifference was not significant (P>0.05), T levels decreased from Child A to C grade,the difference was significant (P <0.05), E2/T ratio increased successively fromChild A to C grade, the difference was significant (P <0.05).5. Comparison of sex hormone level between two groups with different AFPlevels is revealed in table2: in the AFP <400mu g/L group and AFP>400mu g/Lgroup with liver cancer, PRL, E2was not statistically different while the level of Thad a more obvious decline in the AFP <400mu g/L group,and the difference wasstatistically significant (P <0.05). At the same time, E2/T in AFP <400mu g/Lgroup has increased obviously, the difference was statistically significant (P <0.05).6. AFP and E2/T joint test:AFP alone detection sensitivity (14/35,40%),specificity (31/36,86.1%); E2/T alone detection sensitivity (15/35,42.8%),specificity (28/36,77.8%); AFP and E2/T joint test sensitivity (27/35,77%),specificity (26/36,72.2%).Conclusions1.T he imbalance of sex hormones in males were relative with the developmentof hepatocellular carcinoma.2.The E2/T ratio can be used as one of preoperative assessment indicators inpatients for liver transplantation.Combined detection of E2/T and the AFP canimprove the sensitivity of the diagnosis of hepatocellular carcinoma. |
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