胰岛素样生长因子-II 是检测肝细胞癌的有用标志物？

Insulin-like growth factor-II is a useful marker to detect hepatocellular carcinoma?

机构信息

Dipartimento di Medicina Interna, UOC di Medicina interna ad Indirizzo Gastroenterologico, Pad. C, 2° piano, AOU Policlinico Universitario, Via Consolare Valeria, 1-98125 Messina, Italy.

出版信息

Eur J Intern Med. 2012 Sep;23(6):e157-61. doi: 10.1016/j.ejim.2012.04.014. Epub 2012 May 24.

DOI:10.1016/j.ejim.2012.04.014

PMID:22863442

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) is a typical hypervascular tumor. The utility of serum alpha-fetoprotein (α-FP) in its detection is questionable. Over-expression and high circulating levels of insulin-like growth factor-II (IGF-II) were reported in tissue and in serum of patients with HCC. We investigated the diagnostic application of IGF-II in the diagnosis of HCC.

METHODS

Serum IGF-II and α-FP levels were measured in 178 patients (82 with HCC and 96 with liver cirrhosis) and in 30 healthy controls. Spearman test, non parametric combination test and confidence interval analysis were used for statistical evaluation of data.

RESULTS

The best cut-off values selected by ROC curves were 796 ng/ml for IGF-II and 132 ng/ml for α-FP. IGF-II mean values were higher in patients with HCC than in those with liver cirrhosis (LC) (p=0.0001) but lower in LC than in controls (p=0.0001). Serum IGF-II levels above cut-off were found in 22% of patients with HCC, in 9.3% of those with cirrhosis and in 20% of controls. α-FP serum levels >132 ng/ml were observed in 48% of HCC, in 3.1% of LC and in none of control group. By correlation study, serum IGF-II levels were significantly correlated with serum α-FP levels (r=0.427, p=0.0001) and with nodules' diameter (r=0.252, p=0.0130) but not with nodules' number (p>0.050). Finally, IGF-II showed lower sensitivity, specificity and predictive values than α-FP.

CONCLUSION

Circulating IGF-II is not a useful marker for HCC. Further researches are however needed to evaluate its diagnostic accuracy before and after nutritional adjustment.

摘要

背景

肝细胞癌（HCC）是一种典型的富血管肿瘤。血清甲胎蛋白（α-FP）在其检测中的应用受到质疑。研究报道，组织和 HCC 患者血清中胰岛素样生长因子-II（IGF-II）过度表达和高循环水平。我们研究了 IGF-II 在 HCC 诊断中的应用。

方法

检测了 178 例患者（82 例 HCC 和 96 例肝硬化）和 30 例健康对照者的血清 IGF-II 和 α-FP 水平。采用 Spearman 检验、非参数组合检验和置信区间分析对数据进行统计评估。

结果

ROC 曲线选择的最佳截断值分别为 IGF-II 为 796ng/ml 和 α-FP 为 132ng/ml。HCC 患者的 IGF-II 平均值高于肝硬化（LC）患者（p=0.0001），但低于对照组（p=0.0001）。IGF-II 血清水平超过截断值的 HCC 患者占 22%，LC 患者占 9.3%，对照组占 20%。血清 α-FP 水平>132ng/ml 的 HCC 患者占 48%，LC 患者占 3.1%，对照组无患者。相关性研究显示，血清 IGF-II 水平与血清 α-FP 水平显著相关（r=0.427，p=0.0001），与结节直径相关（r=0.252，p=0.0130），但与结节数量无关（p>0.050）。最后，IGF-II 的敏感性、特异性和预测值均低于 α-FP。