Di Bisceglie Adrian M, Sterling Richard K, Chung Raymond T, Everhart James E, Dienstag Jules L, Bonkovsky Herbert L, Wright Elizabeth C, Everson Gregory T, Lindsay Karen L, Lok Anna S F, Lee William M, Morgan Timothy R, Ghany Marc G, Gretch David R
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saint Louis University School of Medicine, 3635 Vista Avenue, St Louis, MO 63110, USA.
J Hepatol. 2005 Sep;43(3):434-41. doi: 10.1016/j.jhep.2005.03.019.
BACKGROUND/AIMS: Alpha-fetoprotein (AFP) has been useful in the diagnosis of hepatocellular carcinoma (HCC) but lacks specificity. We assessed serum AFP among patients with chronic hepatitis C and advanced fibrosis to establish predictors of AFP elevations and changes with antiviral therapy.
Serum AFP was measured at baseline and on therapy in patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis (HALT-C). AFP levels were correlated with patient demographic and clinical features.
Baseline AFP was > or = 20 ng/mL in 191 of 1145 patients (16.6%). Mean AFP values were significantly higher in patients with cirrhosis than in those with bridging fibrosis (22.5 vs. 11.4 ng/mL, P < 0.0001). Factors independently associated with raised serum AFP in patients with cirrhosis were female gender, black race, decreased platelet count, increased serum AST/ALT ratio, serum ferritin, and Mallory bodies in liver biopsies. Serum AFP levels decreased significantly during therapy with pegylated interferon alpha-2a and ribavirin. HCC was identified in six subjects, only three of whom had AFP > 20 ng/mL.
Among patients with advanced chronic hepatitis C, serum AFP values are frequently elevated, even in the absence of HCC. Factors associated with raised AFP include severity of liver disease, female gender and black race. Serum AFP levels decline during antiviral therapy.
背景/目的：甲胎蛋白（AFP）在肝细胞癌（HCC）的诊断中具有一定作用，但缺乏特异性。我们评估了慢性丙型肝炎和晚期纤维化患者的血清AFP水平，以确定AFP升高的预测因素以及抗病毒治疗期间的变化情况。
在丙型肝炎抗病毒长期治疗对抗肝硬化（HALT-C）研究中，对患者在基线期和治疗期间测量血清AFP。AFP水平与患者的人口统计学和临床特征相关。
1145例患者中有191例（16.6%）基线AFP≥20 ng/mL。肝硬化患者的平均AFP值显著高于桥接纤维化患者（22.5对11.4 ng/mL，P<0.0001）。肝硬化患者血清AFP升高独立相关的因素包括女性性别、黑人种族、血小板计数降低、血清AST/ALT比值升高、血清铁蛋白以及肝活检中的马洛里小体。使用聚乙二醇化干扰素α-2a和利巴韦林治疗期间，血清AFP水平显著下降。6例患者被诊断为HCC，其中只有3例AFP>20 ng/mL。
在晚期慢性丙型肝炎患者中，即使没有HCC，血清AFP值也经常升高。与AFP升高相关的因素包括肝病严重程度、女性性别和黑人种族。抗病毒治疗期间血清AFP水平下降。
