CAJ | 학술논문

目的：探讨肝细胞癌患者外周血中微小转移及其临床意义。方法：用巢式逆转录聚合酶链反应(Nested-RT-PCR)技术检测65例肝细胞癌、21例非肝癌的恶性肿瘤、22例慢性乙型肝炎或肝硬化患者及21例健康志愿者外周静脉血中的甲胎蛋白(AFP)mRNA。结果：AFPmRNA在健康志愿者、非肝癌恶性肿瘤患者外周血中均为阴性；在肝细胞癌组外周血中AFPmRNA的检出率(67.7％，44/65)明显高于慢性乙型肝炎或肝硬化组(9.1％，2/22，P<0.01)。AFP-mRNA检出率与临床分期、门静脉癌栓、肝外转移显著相关。经1年的随访发现治疗后外周血AFP-mRNA阳性与肝癌患者预后有显著相关。在12例血清AFP<25μg/L的肝癌病人血中，7例(58.3％)可检出AFP-mRNA。结论：AFP-mRNA可作为血循环中有肝癌细胞或肝细胞的标志物，在肝癌患者，阳性预示有血源性转移的可能，可作为预测肝癌复发、转移的参考指标；并且AFPmRNA对血清AFP阴性或低值的肝癌患者能起到补充诊断作用。
목적：탐토간세포암환자외주혈중미소전이급기림상의의。방법：용소식역전록취합매련반응(Nested-RT-PCR)기술검측65례간세포암、21례비간암적악성종류、22례만성을형간염혹간경화환자급21례건강지원자외주정맥혈중적갑태단백(AFP)mRNA。결과：AFPmRNA재건강지원자、비간암악성종류환자외주혈중균위음성；재간세포암조외주혈중AFPmRNA적검출솔(67.7％，44/65)명현고우만성을형간염혹간경화조(9.1％，2/22，P<0.01)。AFP-mRNA검출솔여림상분기、문정맥암전、간외전이현저상관。경1년적수방발현치료후외주혈AFP-mRNA양성여간암환자예후유현저상관。재12례혈청AFP<25μg/L적간암병인혈중，7례(58.3％)가검출AFP-mRNA。결론：AFP-mRNA가작위혈순배중유간암세포혹간세포적표지물，재간암환자，양성예시유혈원성전이적가능，가작위예측간암복발、전이적삼고지표；병차AFPmRNA대혈청AFP음성혹저치적간암환자능기도보충진단작용。
Objective： The current study was designed to search into the detection of micrometastasis in peripheral blood in the patients with hepatocellular carcinoma(HCC)and its significance.Method： Peripheral blood samples were obtained from 65 patients with hepatocellular carcinoma, 21 non-HCC malignant tumors, 22 chronic hepatitis B or cirrhosis, and 21 cases of normal healthy volunteers. For identifying hepatocellular carcinoma cells in peripheral blood, the authors detected liver-specific alpha-fetoprotein(AFP) mRNA from total RNA extracted from whole blood by nested reverse transcription-polymerase chain reaction(Nested-RT-PCR). Results： AFP-mRNA was not detected in the normal healthy volunteers and the patient with non-HCC malignant tumors. The presence of AFP-mRNA in the patients with HCC (67.7％ ,44/65) was higher than those with chronic hepatitis B or cirrhosis ( 9.1％ ,2/22,P< 0.01). The detective rate of AFP-mRNA in the blood seemed to be correlated with the clinical stages of HCC, the presence of extrahepatic metastasis, and portal vein thrombosis. The positive AFP-mRNA in peripheral blood after treatment was correlated with the prognosis of the patients with HCC. AFP-mRNA was detected in 7 of 12 (58.3％) HCC patients with low level of serum AFP (< 25 μg/L). Conclusions： The presence of AFP-mRNA in peripheral blood may be an indicator of malignant or benign hepatocytes, which might predicate hematogenous spreading metastasis of tumor cells in the patients with HCC, it might be a valuable marker for predicting metastasis and recurrence of HCC, and it might play a supplementary role in the diagnosis of HCC with negative or low level of serum AFP.