Hepatic Cancer肝癌-英文-医学课件.pptVIP

正常和门脉高压状态门静脉血流 (A) Normal portal venous blood flow. PV, portal vein; Cov, coronary vein; SpV, splenic vein; SMV, superior mesenteric vein. A B (B) Portal venous blood flow in the pressence of portal hypertension and GRS. Note reversal of flow in the coronary vein resulting in esophageal varices, and reversal of flow in the splenic vein resulting in gastric varices, which decompress via the GRS. LKID, left kidney; LRV, left renal vein; IVC, inferior vena cava. * 原发性肝癌诊断手段 肿瘤标记物检测 　甲胎蛋白（AFP）及其它 影像学检查 肝穿刺活检 其它：剖腹探查 * 实验室检查 肿瘤标记物检测 甲胎蛋白（alpha-fetoprotein, AFP） 用肝细胞癌普查、诊断，判断疗效，预测复发 早期性 专一性 阳性率70%-90% 诊断标准 AFP400μg/L AFP由低浓逐渐升高不降 APF200μg/L持续8周 应排除妊娠和生殖胚胎瘤及活动性慢性肝病 AFP异质体：肝癌血清中LCA结合型25%，良性肝病结合型25%, 有助于提高PHC诊断率，且不受AFP浓度、肿瘤大小和病情早晚影响 AFP单克隆克抗体 * 实验室检查 肿瘤标记物检测 ?-谷氨酰转移酶同工酶II（GGT2） 原发和转移阳性率达90%，特异性达97.1%，与AFP无关。 异常疑血酶原（AP） 肝癌阳性率达67% α-l岩藻糖苷酶 （AFU） 诊断敏感性为75%，特异性为90% 其他 酸性同工铁蛋白（AIF）、醛缩酶A（ALD-A）、5’-核苷酸磷酸二酯酶同工酶V（5’-NPD –5） * AFP和AFP异质体检测: 针对原发性肝细胞癌 有助于AFP阴性的原发性肝癌的诊断和鉴别诊断 肿瘤标记物检测 ?-谷氨酰转移酶同工酶II（GGT2） 原发和转移阳性率达90%，特异性达97.1%，与AFP无关。 异常疑血酶原（AP） 肝癌阳性率达67% α-l岩藻糖苷酶 （AFU） 诊断敏感性为75%，特异性为90% 其他 酸性同工铁蛋白（AIF）、醛缩酶A（ALD-A）、5’-核苷酸磷酸二酯酶 Marker Sensitivity (%) Specificity (%) Comments Alpha-fetoprotein High-incidence populations: 80-90 90 Relatively quick and easy to measure; most extensively studied ? Low-incidence populations: 50-70 ? ? ? ? ? Relatively expensive Des-γ-carboxyprothrombin 58-91 84 Quick and easy to measure ? ? ? Much more expensive than a-fetoprotein α-L-Fucosidase 75 70-90 Quick and easy to measure; relatively inexpensive Table ? ?Tumor Markers of Hepatocellular Carcinoma Note that sensitivity and specificity rates vary both with the population under study and with the absolute level of the marker. Thus, the specificity of a markedly elevated alpha-fetoprotein level in patients with cirrhosis greatly exceeds the sensitivity of mildly elevated levels in persons without cirrhosis. * 影像学检查 超声显像 目前筛查首选方法。查出直径为1CM以上的肿瘤，利用多谱勒或超声造影，了解供血状态。结合AFP用于普查，有利于早期诊断 增强CT/磁共振显像（MRI