Takaya Hiroaki, Namisaki Tadashi, Kitade Mitsuteru, Shimozato Naotaka, Kaji Kosuke, Tsuji Yuki, Nakanishi Keisuke, Noguchi Ryuichi, Fujinaga Yukihisa, Sawada Yasuhiko, Saikawa Soichiro, Sato Shinya, Kawaratani Hideto, Moriya Kei, Akahane Takemi, Yoshiji Hitoshi
Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara 6348522, Japan.
World J Gastrointest Oncol. 2019 Oct 15;11(10):887-897. doi: 10.4251/wjgo.v11.i10.887.
Early diagnosis of hepatocellular carcinoma (HCC) is necessary to improve the prognosis of patients. However, the currently available tumor biomarkers are insufficient for the early detection of HCC. Acylcarnitine is essential in fatty acid metabolic pathways. A recent study reported that a high level of acylcarnitine may serve as a useful biomarker for the early diagnosis of HCC in steatohepatitis (SH) patients. In contrast, another study reported that the level of acetylcarnitine (AC2) - one of the acylcarnitine species - in non-SH patients with HCC was decreased that reported in those without HCC.
To investigate the usefulness of acylcarnitine as a biomarker for the early diagnosis of HCC in non-SH patients.
Thirty-three non-SH patients (14 with HCC and 19 without HCC) were enrolled in this study. Blood samples were obtained from patients at the time of admission. The levels of acylcarnitine and AC2 in the serum were determined through tandem mass spectrometry. The levels of vascular endothelial growth factor (VEGF) and VEGF receptor 2 (VEGFR-2) were determined by enzyme-linked immunosorbent assay. Univariate and multivariate analyses were used to determine early diagnostic factors of HCC.
The level of acylcarnitine was significantly lower in non-SH patients with HCC those without HCC ( < 0.05). In contrast, the level of lens culinaris agglutinin-reactive fraction of α-fetoprotein (AFP) - AFP-L3% - was significantly higher in non-SH patients with HCC those without HCC ( < 0.05). However, the levels of total carnitine, free carnitine, AFP, des-γ-carboxy prothrombin, VEGF, and VEGFR-2 were not different between patients with and without HCC. The multivariate analysis showed that a low level of acylcarnitine was the only independent factor for the early diagnosis of HCC. The patients with a low level of AC2 had a significantly higher level of VEGF those with a high level of AC2 ( < 0.05).
The metabolic pathways of fatty acids may differ between SH HCC and non-SH HCC. Further studies are warranted to investigate these differences.
肝细胞癌（HCC）的早期诊断对于改善患者预后至关重要。然而，目前可用的肿瘤生物标志物不足以用于HCC的早期检测。酰基肉碱在脂肪酸代谢途径中至关重要。最近一项研究报道，高水平的酰基肉碱可能作为非酒精性脂肪性肝炎（SH）患者HCC早期诊断的有用生物标志物。相比之下，另一项研究报道，HCC非SH患者中酰基肉碱种类之一的乙酰肉碱（AC2）水平低于无HCC患者。
研究酰基肉碱作为非SH患者HCC早期诊断生物标志物的有用性。
本研究纳入了33例非SH患者（14例HCC患者和19例无HCC患者）。在患者入院时采集血样。通过串联质谱法测定血清中酰基肉碱和AC2的水平。通过酶联免疫吸附测定法测定血管内皮生长因子（VEGF）和VEGF受体2（VEGFR-2）的水平。采用单因素和多因素分析确定HCC的早期诊断因素。
HCC非SH患者的酰基肉碱水平显著低于无HCC患者（P<0.05）。相比之下，HCC非SH患者中α-甲胎蛋白（AFP）的豆凝集素反应性部分-AFP-L3%-水平显著高于无HCC患者（P<0.05）。然而，HCC患者和无HCC患者之间的总肉碱、游离肉碱、AFP、异常凝血酶原、VEGF和VEGFR-2水平没有差异。多因素分析显示，低水平的酰基肉碱是HCC早期诊断的唯一独立因素。AC2水平低的患者的VEGF水平显著高于AC2水平高的患者（P<0.05）。
SH HCC和非SH HCC之间的脂肪酸代谢途径可能不同。有必要进一步研究这些差异。
