研究甲胎蛋白异质体3(AFP-L3)、甲胎蛋白(AFP)、血管内皮生长因子(VEGF)在老年人原发性肝癌(PHC)的诊断及肝动脉化疗栓塞(TACE)治疗的临床意义。

选择2014年6月至2016年12月就诊于福建医科大学附属第二医院普通外科的60岁以上老年患者，共72例，其中PHC组42例，肝良性肿瘤组患者30例。采用双抗体夹心酶联免疫吸附测定(ELISA)检测血清VEGF水平，电化学发光法检测AFP和AFP-L3水平，微量离心柱法分离AFP-L3，并计算AFP-L3%。

42例PHC患者中肝硬化组AFP、VEGF表达高于无肝硬化组(t＝6.38，12.10；均P<0.05)；肿瘤直径>5 cm组AFP、AFP-L3、VEGF表达高于肿瘤直径≤5 cm组(t＝17.30，10.72，6.21；均P<0.05)；肿瘤多发组AFP、AFP-L3、VEGF表达高于肿瘤单发组(t＝9.07，13.83，9.44;均P<0.05)。PHC组AFP、AFP-L3、VEGF水平高于肝良性肿瘤组(t＝19.06，17.90，20.20；均P<0.01)。AFP在TACE后1个月的表达水平明显低于术前(q＝9.04，P<0.01)。VEGF术后1周的表达水平低于术前(q＝11.62，P<0.01)。AFP-L3术后1周和术后一个月的表达水平均低于术前(q＝13.30，9.03；均P<0.01)。将PHC患者按照AFP浓度分为2组，比较2组间AFP-L3%阳性率，差异无统计学意义(χ²＝2.88，P>0.05)。AFP-L3、AFP和VEGF ROC曲线下面积分别为0.83，0.79，0.68，AFP-L3线下面积最大；AFP-L3、AFP、VEGF三项单独检测的敏感度分别为82.1%、67.3%、59.7%，特异度分别为76.7%、72.5%、80.1%。AFP-L3的敏感度和特异度均显著高于AFP(χ²＝5.92，P<0.05)；将AFP及AFP-L3联合检测后发现，敏感度为94.1%，特异度为55.6%。三者联合诊断的敏感度为97.6%，特异度为47.6%。

血清AFP-L3诊断PHC的价值优于AFP，多种血清标志物联合检测可相互弥补单一检测的不足，从而提高PHC诊断的阳性率；尤其是对于PHC的早期诊断，具有更好的临床应用价值。

To investigate the clinical significance of alpha-fetoprotein (AFP) variant (AFP-L3), AFP and vascular endothelial growth factor (VEGF) in the diagnosis of elderly primary hepatic carcinoma (PHC) and the treatment of transcatheter arterial chemoembolization (TACE).

Sevnty-two cases of elderly hepatic lesions in the second Affiliated Hospital of Fujian Medical University were enrolled.Forty-two cases of PHC elder patients (PHC group), 30 cases of benign tumor of liver (benign tumor liver group) were selected.VEGF was detected by double antibody sandwich ELISA, AFP and AFP-L3 were detected with electrochemical luminescence immunoassay (ECLIA), AFP-L3 was isolated with lens culinaris agglutinin (LCA)-coupled spin column(ACSC).

The serum levels of AFP and VEGF in hepatic cirrhosis group were significantly higher than those in no cirrhosis group (t=6.38, 12.10, P<0.05). The serum levels of AFP, AFP-L3 and VEGF in tumor diameter >5 cm group were higher than those in tumor diameter ≤5 cm group (t=17.30, 10.72, 6.21, P<0.05). The serum levels of AFP, AFP-L3 and VEGF in multiple tumor group were higher than those in tumor single tumor group (t=9.07, 13.83, 9.44, P<0.05). The serum levels of AFP, AFP-L3 and VEGF in PHC group were significantly higher than those in benign tumor of liver group (t=19.06, 17.90, 20.20, P<0.01). The serum level of postoperative AFP was significantly lower than that of preoperative level (q=9.04, P<0.01). The serum level of postoperative VEGF was significantly lower than that of preoperative level(q=11.62, P<0.01). One week and one month after operation, the serum levels of AFP-L3 were lower than that before the surgery level (q=13.30, 9.03, P<0.01). The areas of AFP, AFP-L3, VEGF under the ROC curve in the differential diagnosis of PHC were 0.83, 0.79, 0.68, and the area of AFP-L3 was the largest.The sensitivity and specificity of AFP-L3 were 82.1% and 76.7%, the sensitivity and specificity of AFP were 67.3% and 72.5%, the sensitivity and specificity of VEGF were 59.7% and 80.1%.Compared with the single detection, the sensitivity and specificity of AFP+ AFP-L3 were 94.1% and 55.6%, the sensitivity and specificity of AFP+ AFP-L3+ VEGF were 97.6% and 47.6%.

The diagnostic value of AFP-L3 is better than that of AFP.The allied combination of serum AFP, AFP-L3 and AFP makes up for the insufficient clinical applications of individual serum makers.