慢性乙型肝炎患者血清AFP動態(tài)監(jiān)測臨床意義.doc

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1、慢性乙型肝炎患者血清AFP動態(tài)監(jiān)測臨床意義【摘要】目的：動態(tài)監(jiān)測慢性乙型肝炎患者血清甲胎蛋白(AFP)變化及肝功能指標(biāo)，探討慢性乙型肝炎各模式與AFP定量變化及肝功能改變的關(guān)系，高度警惕肝癌的發(fā)生。方法：對189例慢性乙型肝炎患者同時用ELISA法進行乙型肝炎五項血清學(xué)標(biāo)志物、用RIA法進行AFP檢測和谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)、谷胺酰轉(zhuǎn)肽酶(GGT)和堿性磷酸酶(ALP)的水平檢測。AFP升高者分別作B超、CT檢查,排除肝癌后每2個月復(fù)查1次AFP、肝功、B超,連續(xù)進行2a~5a追蹤隨訪。結(jié)果：189例中146例AFP不同程度和不同類型

2、升高。隨訪中HBsAg、抗HBe及抗HBc3項陽性(即“小三陽”)中發(fā)現(xiàn)AFP穩(wěn)定上升型的11例(15.5%)均發(fā)展為肝癌；HBsAg、HBeAg及抗HBc3項陽性即“大三陽”中發(fā)現(xiàn)AFP穩(wěn)定上升型的3例(4.8%)發(fā)展為肝癌；HBsAg、抗HBc2項陽性組中1例AFP穩(wěn)定上升型發(fā)展為肝癌。一過性升高和一直未升高型均未出現(xiàn)肝癌。結(jié)論：慢性乙型肝炎小三陽感染模式動態(tài)監(jiān)測AFP變化,對早期發(fā)現(xiàn)肝癌有重要價值?！娟P(guān)鍵詞】慢性乙型肝炎；AFP；肝癌　　ClinicalSignificanceofDynamicObservationonSerumAFPin

3、PatientswithChronicHepatitisBVirus　Abstract：ObjectiveMonitoringdynamiclevelofserumAFPandtheirmarkerofliverfunction,todiscusstherelationshipbetweenHBVinfectionmodesandAFPchangelevelandliverfunctioninpatientswithchronichepatitisBvirus,andfindthediagnosticvalueaboutprimaryhepatocell

4、ularcarcinoma.MethodsHBVinfectionmodesaredetectedbyELISAandAFPbyRIAandALT,AST,GGT,ALPbybiochemicalassaysimultaneityin189patientswithchronichepatitisBvirus.Btypeultrasonicandcomputerizedtomography(CT)wereconductedonthosewhoseAFPrisewasfoundforthefirsttimesoastoexcludelivercancer,a

5、ndthentheyweretestedonhepaticfunctionandretestedonAFPandBtypeultrasoniceverytwomonthsandwerefollowedupsuccessivelyuptotwoandfiveyears.ResultsOfthe189hepatitisBvirusinfectionchildrenpatients,146riseddissimilarlyindegreeandtypeaboutAFPlevel.Accordingtothefollowup,11caseswhoseAFPl

6、evelkeptrisingsteadilywithHBsAg、antiHBeandantiHBcpositivemodelsand3casewhosewhoseAFPlevelkeptrisingsteadilywithHBsAg、HBeAgandantiHBcpositivemodelsallbecameprimaryhepatocellularcarcinoma.ButNolivercancerwasfoundamongthosewhoseAFPlevelrisedephemerallyandwhoseAFPlevelneverrised.C

7、onclusionItisvaluableforchronichepatitisBviruspatientswithHBsAg、antiHBeandantiHBcpositivemodelstodynamiciallyobserveon4itsAFPlevel,theymayfindprimaryhepatocellularcarcinomaearlier.Keywords：ChronichepatitisBvirus;AFP;Hepatocellularcarcinoma甲胎蛋白(AFP)主要是由胚胎肝細(xì)胞、卵黃囊和胃腸上皮細(xì)胞產(chǎn)生的一種特殊球蛋白。

8、健康成年人血清AFP水平小于20ng/ml，1964年Tatarinov發(fā)現(xiàn)原發(fā)