Serum alpha-1-antitrypsin and alpha-1-antichymotrypsin in the diagnosis of primary hepatocellular carcinoma.

Both alpha-1-antitrypsin (AAT) and alpha-1-antichymotrypsin (AAC) in serum were investigated in various liver diseases. Serum levels of AAT and AAC in normal controls were 293.3 +/- 37.9mg/dl and 119.6 +/- 18.9U/ml, respectively. Both AAT and AAC were significantly higher in 75 patients with primary hepatocellular carcinoma (PHC) than in patients with acute viral hepatitis, chronic hepatitis, liver cirrhosis as well as normal controls. In a cut-off value of more than 400 mg/dl AAT showed a sensitivity rate (SS) of 74.7%, specificity (SP) of 97.3%, positive predictive value (PV+) of 86.2%, negative predictive value (PV-) of 95.5% and a total accuracy of 93.3% for diagnosing PHC. In a cut-off value of more than 157 U/ml, the corresponding figures for AAC were 68.0%, 96.7%, 86.4%, 90.6% and 90.0%. If the increased levels in one or both tests are positive, the combined positive rate is 80.0% in PHC. In 11 PHC cases with serum alpha-fetoprotein (AFP) less than 50 ng/ml, the positive rate of AAT and AAC were 72.7% and 81.8%, respectively, compared to corresponding figures of 71.7%, and 65.2% in 46 cases of PHC with more than 50 ng/ml of AFP. It shows that combined assay of both serum AAT and AAC has a complemental value in the diagnosis of PHC, especially in patients without increased AFP.