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目的:探讨AFPmRNA在原发性肝癌患者外周血的表达及其动态变化和临床意义。方法:用巢式逆转录聚合酶链反应检测93例肝癌患者外周血AFPmRNA,并观察其中36例患者血AFPmRNA表达在治疗前后的动态变化。结果:血AFPmRNA阳性率为52.7%(49/93),阳性率与肝癌临床分期、门静脉癌栓、肝外转移、癌灶大小、HBV感染和肝硬化程度密切相关,并和癌组织中AFPmRNA的表达水平密切相关(P<0.05)。随访结果显示,外周血AFPmRNA呈阳性的病例发生肝内外转移率显著高于阴性病例,癌灶缓解期明显短于阴性病例(P均<0.05)。联合全身化疗和免疫治疗可显著降低肝癌患者外周血AFPmRNA的阳性率。结论:外周血AFPmRNA阳性表达是预示肝癌发生肝内外转移的重要标志。联合全身化学免疫治疗可显著降低血AFPmRNA阳性率,对预防肝癌细胞的血行播散、降低肝内外转移率和提高患者预后可能有积极作用。
Objective: To investigate the expression, dynamic changes and clinical significance of AFP mRNA in patients with primary liver cancer. METHODS: AFP mRNA was detected in peripheral blood of 93 patients with hepatocellular carcinoma by nested reverse transcription polymerase chain reaction (RT-PCR), and the dynamic changes of blood AFP mRNA expression before and after treatment were observed in 36 patients. Results: The positive rate of AFP mRNA in blood was 52.7% (49/93). The positive rate was closely related to the clinical stage of liver cancer, portal vein tumor thrombus, extrahepatic metastasis, tumor size, HBV infection and liver cirrhosis, and the AFPmRNA in cancer tissues. The level of expression was closely related (P<0.05). Follow-up results showed that the rate of intra- and extra-hepatic metastases was significantly higher in peripheral blood AFPmRNA-positive cases than in negative cases, and the remission period was significantly shorter in the tumors than in the negative cases (P<0.05). Combined systemic chemotherapy and immunotherapy can significantly reduce the positive rate of peripheral blood AFPmRNA in patients with liver cancer. Conclusion: The positive expression of AFP mRNA in peripheral blood is an important indicator of hepatic metastasis of liver cancer. The combination of whole body chemical immunotherapy can significantly reduce the positive rate of AFP mRNA in blood, and it may have a positive effect on prevention of hematopoietic cell dissemination, reduction of hepatic metastasis rate, and improvement of patient prognosis.