【摘要】 目的:探讨血清AFP水平和组织中谷氨酰胺合成酶(glutamine synthetase, GS)、磷脂酰肌醇蛋白聚糖-3(glypican-3,GPC3)蛋白在老年丙肝相关肝硬化(HCV-related liver cirrhosis, HCV-Crri)和老年丙肝相关肝癌(HCV-related hepatocellular carcinoma, HCV-HCC)中的表达及其临床意义。方法:采用电化学发光分析和免疫组织化学检测40例老年丙肝相关肝硬化、32例老年丙肝相关肝癌材料和30例老年对照组血清AFP水平和组织中GS、GPC3蛋白的表达，分析评价老年丙肝相关肝癌及癌前病变中血清AFP水平和组织中GS、GPC3蛋白的表达及其与临床病理因素之间的关系。结果:老年HCV-Crri组和HCV-HCC组中血清AFP水平均高于正常对照组(P<0.05),而老年HCV-Crri组与HCV-HCC组之间血清AFP水平差异无统计学意义(P>0.05)。GS和GPC3蛋白在HCV-Crri组和HCV-HCC组中的阳性表达率分别为10.0%(4/40)、87.5%(28/32)和27.5%(11/40)、78.1%(25/32),HCV-HCC组均显著高于HCV-Crri组(P<0.05),而两者在对照组中均为阴性表达。HCV-HCC组中11例AFP阴性病例中GS和GPC3联合检测阳性率为72.7%(8/11),HCV-HCC组中GS蛋白的表达与GPC3蛋白的表达呈显著正相关(r=0.486,P=0.02)。HCV-HCC组中GPC3蛋白在肿瘤病理分级III-IV级和TNM分期III-IV期中的阳性表达率均显著高于I-II级和I-II期(P=0.03),而GS蛋白的表达与肿瘤病理分级和TNM分期无关。结论:GS、GPC3蛋白在老年丙肝相关肝癌组织中的高表达，与老年丙肝相关肝癌的发生、发展和转移有关，联合检测组织中GS和GPC3蛋白的表达有助于临床提高对老年丙肝相关肝癌的诊断率和科学评价预后，尤其在血清AFP水平呈阴性的老年丙肝相关肝癌患者中。更多还原

【Abstract】 Objective:To investigate the expression and clinical significance of serum AFP level and tissue GS,GPC3 protein in elderly patients with HCV-related hepatocellular carcinoma.Methods:Electrochemiluminescence analysis and immunohistochemical staining technique were used to detect serum AFP level and tissue GS, GPC3 protein in 40 elderly patients with HCV-related cirrhosis(HCV-Crri),32 elderly patients with HCV-related hepatocellular carcinoma(HCV-HCC) and 30 cases of elderly normal control groups.To analysis and evaluate of the serum AFP level and the expression of GS and GPC3 protein in HCV-related hepatocellular carcinoma and precancerous lesions and their relationship with clinicopathological factors.Results:The levels of serum AFP in the elderly HCV-Crri and HCV-HCC groups were higher than those in the normal control group(P<0.05),but there was no significant difference between the elderly HCV-Crri and HCV-HCC groups(P>0.05).The positive expression rates of GS and GPC3 proteins in the HCV-Crri group and the HCV-HCC group were 10.0%(4/40),87.5%(28/32) and 27.5%(11/40),78.1%(25/32),respectively, which were significantly higher in the HCV-HCC group than the HCV-Crri group(P<0.05),while both were negatively expressed in the control group.The positive rate of combined detection of GS and GPC3 in 11 AFP negative cases in the HCV-HCC group was 72.7%(8/11).There was a significant positive correlation between the expression of GS protein and GPC3 protein in HCV-HCC group(r=0.486,P=0.02).The positive expression rate of GPC3 protein in HCV-HCC group in tumor pathological grade III-IV group and TNM stage III-IV group was significantly higher than those in grade I-II and stage I-II group( P = 0. 03),while the expression of GS protein was not related to tumor pathological grade and TNM stage. Conclusion: The high expression of GS and GPC3 protein in elderly HCV-HCC tissue may correlate to tumorgenesis,development and metastasis of HCV-HCC in the elderly. Combined detection of the expression of GS and GPC3 protein in the tissues may help clinically improve the diagnosis rate and evaluate the prognosis of HCV-HCC in elderly patients,especially those with negative serum AFP level.更多还原