Diagnostic Value Of Determination Of Serum AFP,CA19-9,AFU,TGF-β₁ In Patients With Liver Cancer

PrefacePrimary hepatic carcinoma ( PHC) is one of the malignant tumors in digestive system. Beside lung carcinoma, its mortality rate is the second highest a-mong city in our country. Early diagnosis and early treatment are still the methods to reduce its mortality rate. At present, its early detection rate is low and u-sually relying on imageology detection etc. , so when discovered the disease was usually in middle or advanced stage. So it is important to study and research the method to early diagnosis PHC. In addition, the stage judgement of PHC has significant meaning for prognosis and clinical treatment.Marker of tumor is a kind of antigen or bioactive compound that expressed by tissue or cell in tumor when its gene, antioncogene or tumor related gene a-nomaly expressing. Normal tissue and optimum disease scarcely express the marker of tumor. Its expression embodies the existance and development of tumor and the activation, inactivation of tumor related gene. It can be detected in body fluid and excretion. Ideal marker of tumor should be of high specificity and suitable for whole population survey.In this research, we collected sera from hepatic carcinoma patient and compared the masculine rate, sensitivity, specificity and degree of accuracy of several kinds of tumor marker in one object with the help of imageology and pathology diagnosis. To clarify the value of AFP, CA19 -9, AFU and TGF - β₁ detection and their combine detection in diagnosis of hepatic carcinoma.Object and methodsObject1.1.1 Group of liver cancer: 60 example, male 51, female 9, aged from 38 to 77. PHC was judged by diagnostic criteria of Zhong Guo Chang Jian E Xing Zhong Liu Zhen Zhi Gui Fan Di Er Fen Ce and were confirmed by operation, intervention and pathology.1.1.2 Group of cirrhosis: 30 example, male 17, female 13, aged from 37 to 70. Diagnosed by combination of clinical manifestation, biochemistry, ultrasound, CT and MRI detection etc. and excluded the position occupied pathological changes in liver.1.1.3 Group of hepatitis: 30 example, male 26, female 4, aged from 27 to 78. Diagnosed by combination of clinical manifestation, biochemistry, ultrasound, CT and MRI detection etc.1.1.4 Group of normal control: 30 example, male 25 , female 5, aged from 24 to 42. They are healthy classmates or colleages by medical examination of our hospital.1.2 methods1.2. 1 Collection and handling of specimen: Empty stomach venous blood 5ml was collected in all subject, blood serum were separated and stored at -70°C for detection.1. 2. 2 Detection methods;AFP and CA19 -9 were detected by chemilumi-nescence ( kit provided by Ya Pei company) , AFU was detected by velocity method (kit provided by Wen Zhou Kang company) and TGF - (3, was detected by double antibody sandwich ABC - ELISA ( kit provided by Shang Hai Sen Xiong limited company) in the biochemistry room of the second affiliated hospital of China Medical University,1. 3 Statisrical analysis;Simultaneous determination results of sera from 150 sample were presented as means standard errors of the means (SEM) . Statistical significance of differences in means was analyzed by Students t test and differences in masculine rate was analyzed by test with SPSS software. A valueof P <0. 05 was considered significant.ResultsCompared with normal control group, sera level of AFP, CA19 -9, AFU and TGF - (3,have significant difference ( P < 0. 001) in groups of liver cancer, cirrhosis and hepatitis. Compared with other groups, in liver cancer group the masculine rate was significant (P<0.001). In liver cancer group the detection sensitivities for AFP, CA19 -9, AFU and TGF - $x were respectively 76. 67% , 55% , 50% and 63. 33% ,the combined detection sensitivity for AFP, CA19 -9 and TGF - fjjwas 96. 67% , the combined detection sensitivity for AFP, CA19-9, AFU and TGF - (Jjwas 96. 67% also. In liver cancer group the detection specificities for AFP, CA19 -9, AFU and TGF - (3, were respectively 71. 11% , 66.67% ,92.22% and 48. 89% ,accuracies were 73.33% , 60.67% , 75. 33% and 54.67% 0 the combined detection sensitivity for AFP, CA19 -9 and TGF- Pj was 96. 67% , there was significant difference ( P < 0. 005) when compared with the sensitivities of solo detection by test. These illustrated that combined detection of them has more superiority which can improve the detection rate of liver cancer and avoid missed diagnosis. This has clinical significance.DiscussionAFP ( alpha fetal protein) : AFP is synthetized by hepatic parenchymal cells in embryo and saccus vitellinus cells and can' t be detected in sera 5 weeks after born. 60 - 70% PHC has increased AFP in sera. Up to now, AFP is still the best serology dioganosis marker of PHC. It is extensively used in the census, diagnosis, judgement of therapeutic efficacy and in predicting recur. Masculine in census can earlier 8-11 months than the appear of symptom. Results of this research shown that masculine rate of AFP in hepatoma patient was 75% and has significant difference (P<0.001) when compared with the other three groups. In hepatoma patient the sensitivity of AFP is 76. 67% ,specificity was 71. 11% , accuracy was 73. 33% .CA19 -9(carbohydrate antigen 19 — 9) : CA19 -9 has important clinical valve in judgement of therapeutic efficacy, prognosis, recurrence prediction and metabasis, especially in the metabasis of tumor. Results of this research shown that masculine rate of CA19 -9 in hepatoma patient was 51. 67% and its sensitivity was 51. 67% , specificity was 66. 67% ,accuracy was 60. 67% .AFU (a - L - fucosidase);in 1980, Franch scholar Deugnier found increased sera AFU activity in PHC patient and reported its level in normal and hepatopath sera, concluded that AFU maybe a useful index for PHC diagnosis. Results of this research shown that masculine rate of AFU in hepatoma patient was 50% and has significant difference (P < 0. 001) when compared with the other three groups. It maybe a liver tumor marker and can improved the sensitivity and accuracy of hepatoma diagnosis when combined detection with AFP. In hepatoma patient the sensitivity of AFU is 50% , specificity was 92. 22% , accuracy was 75. 33%.TGF - 3, (transforming growth factor beta 1 );TGF - p, is an important negative growth factor with powerful reversible growth inhibition activity and im-munosuppressive action. It is closely related to the inhibition of cell mediated immunity in PHC and has extreme function in human body. Compared with normal person, significant higher level of TGF can be detected in sera of c most cancer patients. Results of this research shown significant ( P <0. 001) higher level of TGF was foune in sera of hepatitis, cirrhosis and hepatoma patients when compared with normal group. In PHC diagnosis the sensitivity of TGF - (3, is 63. 33% , specificity was 48. 89% , accuracy was 54.67% . Masculine rate can reach to 96. 67% when combined detection with other tumor markers.The significance of combined detection: Compared with solo detection, the sensitivity of combined detection of AFP, AFU and CA19 -9 can reach to 96. 67% and shown significant difference (P <0.05). This illustrated the superiority of combined detection of them, which can improve the detection rate of liver cancer and avoid missed diagnosis. This has clinical significance.Conclusionl^AFP is the most used fairly specific tumor marker in PHC diagnosis, at present there has not any better tumor marker than can substitute it. It can improve the sensitivity and masculine rate when combined detection with CA19 -9 and AFU.2^ AFU is the second only AFP used fairly specific tumor marker in PHC diagnosis, but its solo detection masculine rate is low. It can highly improve the diagnosis accuracy when combined detection with AFP.3NCA19 -9 is not a specific tumor marker in PHC diagnosis, but it can improve the diagnosis sensitivity and avoid missed diagnosis when combined detection with AFP and AFU.4^TGF - p,is incompetence as a tumor marker. Its detection rate decreased gradually in hepatitis group, cirrhosis group and hepatoma group but there was significant difference when compared with normal group. This suggested it can be a monitoring index for cellular damage of liver.