原发性肝癌外周血白蛋白基因片段扩增临床意义.docVIP

原发性肝癌外周血白蛋白基因片段扩增临床意义 　 作者：朱云松，杨大明，姚登福，孟宪镛，李玉明，钱俊波，王亚明，许利华 【摘要】 　　目的:探讨外周血白蛋白(Alb)基因在肝癌早期诊断和鉴别诊断中的临床价值。方法:以巢式聚合酶链反应(RT-PCR)扩增外周血中Alb的基因片段分析在原发性肝癌（HCC）、慢性肝病和非肝病患者外周血中血白蛋白基因表达。结果: 67例肝癌患者外周血中Alb基因的检出率为59.7%,明显高于肝硬化、慢性肝炎和肝外肿瘤组患者（Plt;0.01),但与急性肝炎组无明显差别（Pgt;0.05);在Ⅰ、Ⅱ和Ⅲ期肝癌中, Alb基因片段阳性率分别为33.3%、36.8%和76.9%;肝内有无转移的肝癌组间存在明显差异（Plt;0.05),尤其在伴有肝外远处转移的肝癌中, Alb基因全数阳性(100.0%)。结论:分析外周血中Alb基因有助于肝癌的诊断、肝癌远处转移判别的监测。 【关键词】 原发性肝癌 Alb基因 RT-巢式PCR 　　[Abstract] Objective: To explore clinical values of peripheral blood albumin gene in early diagnosis and differential diagnosis of hepatocellular carcinoma (HCC). Methods: The Alb gene was amplified by nested reverse transcription polymerase chain reaction(RT-PCR) in patients with hepatocellular carcinoma, chronic liver or non-liver disease. Results: The positive rate of peripheral blood Alb gene fragments from 67 patients with HCC was 59.7%. It was significantly higher than that from the patients with liver cirrhosis (LC), chronic hepatitis (CH) and extrahepatic tumor (ET) （Plt;0.01), but there is no significant difference in positive rates of Alb-mRNA between HCC and acute hepatitis (AH). The Alb-mRNA was correlated with the stage of HCC and the presence of intrahepatic metastasis. The expression of Alb gene was 33.3% in I stage HCC, 36.8% in Ⅱ stage HCC and 76.9% in Ⅲ stage HCC. It was positive in all patients with extrahepatic metastasis(100%). Conclusion: The analysis of peripheral blood Alb gene is useful for diagnosis and differentiation of HCC and judgment extrahepatic metastasis. 　　[Key words] Hepatocellular carcinoma；Albumin gene；Nested reverse transcription polymerase chain reaction 　　原发性肝癌（hepatocellular carcinoma，HCC）是临床最常见、治疗最难的恶性肿瘤,HCC切除和肝移植是治疗的最佳选择,但绝大多数患者在术后发生移植肝或远处复发,其原因是在术前未能检出微转移灶或术中肝癌细胞释放入血所致,因而如能早期准确地检出外周血或淋巴结转移灶,才能设法降低复发率提高生存率[1，2]。本研究以RT-巢式PCR方法分析肝病患者外周血中Alb-mRNA,以观察它们在肝癌诊断、肝癌远处转移判断的临床价值。 　　1 材料与方法 　　1.1 研究对象 门诊和住院患者中收集急性肝炎12例、慢性肝炎20例、肝硬化16例、肝癌67例（男61例，女6例，年龄25~81岁，平均49.8±11.4岁）和非肝肿瘤14例（肺癌和胃癌各5例，食管癌、胰腺癌、结肠癌和胆管癌各1例）。肝癌和肝