慢性丙型肝炎患者无肝细胞癌时甲胎蛋白（AFP）升高的临床意义

Clinical significance of elevated alpha-fetoprotein (AFP) in chronic hepatitis C without hepatocellular carcinoma.

作者信息

Chen Chien-Hua, Lin Shang-Tao, Kuo Chien-Long, Nien Chiu-Kue

机构信息

Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, No. 6, Lugong Road, Lugang Township, Changhua County 505, Taiwan.

出版信息

Hepatogastroenterology. 2008 Jul-Aug;55(85):1423-7.

PMID:18795704

Abstract

BACKGROUND/AIMS: Alpha-fetoprotein is often measured in subjects with chronic hepatitis C for diagnosing hepatocellular carcinoma. However, its prevalence and clinical significance remain inconclusive in subjects without hepatocellular carcinoma. The study was to assess the clinical, virologic, and histopathological significance of elevated AFP in chronic hepatitis C without the presence of hepatocellular carcinoma.

METHODOLOGY

The retrospective study enrolled 102 consecutive subjects with a histological diagnosis of chronic hepatitis C. None had evidence of hepatocellular carcinoma by image study at enrollment and for at least 6 months' follow-up. The correlation between serum alpha-fetoprotein level and clinical, virologic, or histopathological records was reviewed.

RESULTS

The prevalence of elevated serum alpha-fetoprotein (> or = 13.6 ug/L) was 28.4% (29/102) in this study. Hepatic steatosis (> or = 5% hepatocytes), hepatic fibrosis (> or = stage II), uric acid > or = 6.3 mg/dL, asparate aminotransferase > or = 40 IU/L, albumin < 3.5 g/dL, and fasting plasma glucose < 126 mg/dL were significantly associated with elevated AFP in multivariate analysis. However, neither hepatitis C virus genotype Ib infection nor viral load > or = 1x10(6) copies/ml was related to elevated AFP. A serum alpha-fetoprotein level of 15.6 ug/L was 34.3% sensitive and 83.6% specific for hepatic steatosis, was 28.2% sensitive and 95.8% specific for > or = stage II hepatic fibrosis in Chronic hepatitis C.

CONCLUSIONS

Elevated alpha-fetoprotein is independently associated with hepatic steatosis (> or = 5% hepatocytes), > or = stage II hepatic fibrosis, increased level of uric acid (> or = 6.3 mg/dL) or asparate aminotransferase (> or = 40 IU/L), and decreased level of albumin (< 3.5 g/dL) or fasting plasma glucose (< 126 mg/ dL). Viral factors, including hepatitis C virus genotype 1b infection and viral load, are not related to elevated alpha-fetoprotein in hepatitis C virus-infected subjects.

摘要

背景/目的：慢性丙型肝炎患者常检测甲胎蛋白以诊断肝细胞癌。然而，在无肝细胞癌的患者中，其发生率及临床意义仍不明确。本研究旨在评估慢性丙型肝炎且无肝细胞癌患者中甲胎蛋白升高的临床、病毒学及组织病理学意义。

方法

本回顾性研究纳入102例经组织学诊断为慢性丙型肝炎的患者。入组时及至少6个月随访期内，影像学检查均无肝细胞癌证据。回顾血清甲胎蛋白水平与临床、病毒学或组织病理学记录之间的相关性。

结果

本研究中血清甲胎蛋白升高（≥13.6μg/L）的发生率为28.4%（29/102）。多因素分析显示，肝脂肪变性（≥5%肝细胞）、肝纤维化（≥II期）、尿酸≥6.3mg/dL、天冬氨酸转氨酶≥40IU/L、白蛋白<3.5g/dL及空腹血糖<126mg/dL与甲胎蛋白升高显著相关。然而，丙型肝炎病毒1b型感染及病毒载量≥1×10⁶拷贝/ml均与甲胎蛋白升高无关。血清甲胎蛋白水平为15.6μg/L时，对肝脂肪变性的敏感性为34.3%，特异性为83.6%；对慢性丙型肝炎≥II期肝纤维化的敏感性为28.2%，特异性为95.8%。

结论

甲胎蛋白升高与肝脂肪变性（≥5%肝细胞）、≥II期肝纤维化、尿酸水平升高（≥6.3mg/dL）或天冬氨酸转氨酶升高（≥40IU/L）以及白蛋白水平降低（<3.5g/dL）或空腹血糖降低（<126mg/dL）独立相关。病毒因素，包括丙型肝炎病毒1b型感染及病毒载量，与丙型肝炎病毒感染患者中甲胎蛋白升高无关。