胃肝样腺癌血清甲胎蛋白阳性的临床意义(1)
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[摘要] 目的 探讨胃肝样腺癌(hepatoid adenocarcinoma of stomach，HAS)甲胎蛋白(α-fetoprotein，AFP)阳性的临床意义。 方法 分析经病理确诊为胃肝样腺癌患者15例的AFP水平,-包括术前测定其血清AFP浓度改变及术后免疫组化测定的肝样腺癌组织AFP的表达，评价AFP水平在诊断胃肝样腺癌时的价值。 结果 15例患者术前血清AFP浓度范围为1.51~20 000 μg/L；术后癌组织甲胎蛋白表达，AFP染色12例呈阳性，其中，3例呈强阳性(+++)，4例呈阳性(++)，5例呈弱阳性(+)。AFP表达3例呈阴性(-)。AFP 阳性胃癌分为肝样化和肠化两种类型，前者血清AFP较高(即HAS)，后者AFP 滴度较低。 结论 胃肝样腺癌AFP水平波动范围大，血清AFP升高是HAS重要的临床病理特点，AFP水平在HAS诊治中具有重要价值，可作为早期诊断的条件之一，胃癌患者术前应列为常规检查。
[关键词] 肿瘤；胃肝样腺癌；甲胎蛋白
[中图分类号] R735.2 [文献标识码] A [文章编号] 1673-7210(2012)02(c)-0043-04
Clinical significance of the electropositive α-fetoprotein in hepatoid adenocarcinoma of stomach
LI Chen XIA Shaoyou ZHANG Yong
Department of General Surgery, the Chinese General PLA Hospital, Beijing 100853, China
[Abstract] Objective To investigate the expression of AFP in hepatoid adenocarcin of the stomach (HAS). Methods AFP in 15 cases of HAS verified by the pathology was respectively analyzed. Included the serumlevels of AFP ante-operation and the hepatoid adenocarcinom levels of AFP by immunohistochemisty, the worth of AFP was evaluated in HAS diagnosis. Results In the 15 cases, the serum AFP were 1.51-20 000 μg/L; the hepatoid adenocarcinom AFP were detected by immunohistochemisty, 3 cases were hadro-positive, 4 cases were positive, and 5 cases were weakly positive, 3 cases were negative. AFP-positive-HAS included two phenotypes, one was hepatoid with high serum AFP, and the other was enteroid with relatively lower serum AFP. Conclusion Serum AFP in HAS fluctuate in large range. High Serum AFP is an important parameter and has diagnostic value in HAS. Serum AFP represents an early diagnostic parameter and should be routinely tested.
[Key words] Tumor; Hepatoid adenocarcinoma of stomach; α-fetoprotein
甲胎蛋白(AFP)是一种胚胎性蛋白，作为一种特殊的肿瘤标志物，临床上广泛用于肝细胞癌、卵黄囊肿瘤的诊断。近年发现，胃肝样腺癌(HAS)患者有70%~80%血清AFP升高[1]。HAS是具有腺癌和肝细胞癌样分化特征的一种特殊类型的原发性胃癌，生物学行为独特，恶性程度高，预后极差。由于临床罕见，目前对其认识较少，早期诊断非常困难。本文分析了我院2002年8月~2010年11月收治的术前AFP阳性，术后经病理确诊的15例胃肝样腺癌的临床资料，并复习相关文献，评价AFP在胃肝样腺癌诊断中的价值。
1 资料与方法
1.1 一般资料
回顾性分析我院2002年8月~2010年11月收治术前AFP阳性、手术切除后经病理证实为胃肝样腺癌患者15例，其中，男9例，女6例；年龄45~72岁，平均(68±2.4)岁。所有患者既往均无肝炎病史，入院后经各项检查均已排除急、慢性肝炎，肝硬化，肝细胞癌及畸胎瘤。
1.2 甲胎蛋白监测
1.2.1 血清甲胎蛋白监测 入院后患者于术前采集外周静脉血液 ......
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