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目的探讨血清甲胎蛋白异质体3(AFP-L3)占甲胎蛋白(AFP)的比率在肝细胞癌(HCC)肝动脉化疗栓塞术(TACE)后疗效评价中的价值。方法用微量离心柱法分离AFP-L3,电化学发光法检测血清中AFP及AFP-L3的量,计算出AFP-L3占AFP的百分比,以AFP-L3≥10%为阳性判断标准。比较50例患者TACE前后AFP和AFP-L3的变化,结合复查时数字减影血管造影技术(DSA)和增强计算机断层扫描(CT)表现,分析AFP-L3在肝癌TACE疗效评价中的价值。结果根据实体瘤疗效评价标准(RECIST),分为完全缓解(CR)7例、部分缓解(PR)15例、稳定(SD)10例和疾病进展(PD)18例。50例患者术前AFP与术后AFP的差异无统计学意义(P>0.05),术前AFP-L3与术后AFP-L3的差异有统计学意义(P<0.01)。CR+PR+SD者术前AFP与术后AFP的差异有统计学意义(P<0.05),术前AFP-L3与术后AFP-L3的差异有统计学意义(P<0.01),AFP及AFP-L3下降百分率经配对样本比较的Wilcoxon符号秩检验,差异有统计学意义(P<0.01)。结论 AFP-L3是较AFP更准确的评价肝细胞癌TACE后疗效的肿瘤标志物。
Objective To investigate the value of serum AFP-L3 (AFP-AFP) ratio in evaluating the curative effect of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods AFP-L3 was separated by micro-centrifugation column method. The amount of AFP and AFP-L3 in serum was detected by electrochemiluminescence. The percentage of AFP-L3 in AFP was calculated, and AFP-L3≥10% was used as the positive criterion. The changes of AFP and AFP-L3 in 50 patients before and after TACE were compared. The combined evaluation of digital subtraction angiography (DSA) and enhanced computed tomography (CT) was performed to evaluate the value of AFP-L3 in assessing the efficacy of TACE for hepatocellular carcinoma. Results According to the RECIST, there were 7 cases of complete remission (CR), 15 cases of partial remission (PR), 10 cases of stable (SD) and 18 cases of disease progression (PD). There were no significant differences in preoperative AFP and postoperative AFP between the 50 patients (P> 0.05), preoperative AFP-L3 and postoperative AFP-L3 (P <0.01). There was significant difference between preoperative AFP and postoperative AFP in CR + PR + SD (P <0.05), preoperative AFP-L3 and postoperative AFP-L3 (P <0.01), AFP and Wilcoxon signed-rank test comparing the percent reduction of AFP-L3 with matched samples showed significant difference (P <0.01). Conclusion AFP-L3 is a more accurate tumor marker for assessing the efficacy of TACE in hepatocellular carcinoma than AFP.