Farinati F, Annoni G, Donato M F, Nardelli P, Bertozzo A, De Maria N, Zotti S, Salvagnini M, Martinez D, Naccarato R
Cattedra Malattie Apparato Digerente, Università di Padova, Italy.
J Gastroenterol Hepatol. 1990 Nov-Dec;5(6):633-8. doi: 10.1111/j.1440-1746.1990.tb01117.x.
Hepatic fibroplasia seems to play an important role in the course of primary liver cancer (PLC) since, for instance, encapsulated and fibrolamellar hepatocellular carcinomas show a definitely better prognosis. In this study, serum procollagen III amino-terminal peptide (PIIIP) levels, which reflect synthesis and release of procollagen type III, were measured with the aim of assessing hepatic fibrogenesis in PLC patients and determining whether serum PIIIP levels play a diagnostic or prognostic role in PLC. Twenty-five patients with PLC, 74 patients with cirrhosis and 38 healthy volunteers were studied. Serum PIIIP levels were determined by a radioimmunoassay (RIA) method. In PLC patients PIIIP serum levels were significantly higher than those of controls and cirrhotic patients (P less than 0.001 and P less than 0.01 respectively) but an analysis of individual values showed an important overlap between PLC and cirrhosis. No correlation was found between serum PIIIP levels and tumour histology, presence or absence of cirrhosis, Child status, possible aetiology of the disease, indices of hepatocellular inflammation, cholestasis and synthesis, or tumour markers. On the contrary, serum PIIIP levels correlated with tumour gross pattern (z = 3, P less than 0.001) and, inversely, with survival (r = 0.659, P less than 0.01), patients with serum PIIIP over 25 ng/mL showing a significantly worse prognosis. These data confirm that hepatic fibroplasia plays an important, but not yet fully understood, role in the course of PLC. From the clinical point of view, PIIIP determination does not add to the differential diagnosis between PLC and cirrhosis but helps to identify patients with larger liver replacements and worse prognoses.
肝纤维化在原发性肝癌（PLC）病程中似乎起着重要作用，例如，包膜型和纤维板层型肝细胞癌的预后明显更好。在本研究中，测定血清Ⅲ型前胶原氨基端肽（PIIIP）水平，以评估PLC患者的肝纤维化形成，并确定血清PIIIP水平在PLC中是否具有诊断或预后作用。研究了25例PLC患者、74例肝硬化患者和38名健康志愿者。采用放射免疫分析（RIA）法测定血清PIIIP水平。PLC患者的血清PIIIP水平显著高于对照组和肝硬化患者（分别为P＜0.001和P＜0.01），但对个体值的分析显示PLC和肝硬化之间存在重要重叠。血清PIIIP水平与肿瘤组织学、有无肝硬化、Child分级、疾病可能的病因、肝细胞炎症指标、胆汁淤积和合成指标或肿瘤标志物之间均无相关性。相反，血清PIIIP水平与肿瘤大体形态相关（z = 3，P＜0.001），与生存率呈负相关（r = 0.659，P＜0.01），血清PIIIP超过25 ng/mL的患者预后明显更差。这些数据证实肝纤维化在PLC病程中起着重要作用，但尚未完全明确。从临床角度来看，PIIIP测定无助于PLC和肝硬化的鉴别诊断，但有助于识别肝替代范围较大且预后较差的患者。
