Serum B Protein in Hepatocellular Carcinoma and Liver Cirrhosis

血中B蛋白與肝癌及肝硬化關係之研究

張文宇(Wen-Yu Chang) ； 林子堯(Zu-Yau Lin)

《The Kaohsiung Journal of Medical Sciences》 6卷11期 (1990/11) Pp. 599-605

https://doi.org/10.6452/KJMS.199011.0599

摘要

近年研究報告顯示血清中B蛋白可能為一新的腫瘤標記，而本研究之目的即在測試B蛋白是否也可當做肝癌之腫瘤標記使用，又因肝癌患者常合併有肝硬化，故B蛋白與肝硬化之關係也一併加以探討。
共129位病人包括23位肝癌，50位肝癌合併肝硬化，40位肝硬化及16位慢性肝炎，以乳膠凝集試驗測定白清中之B 蛋白濃度。結果發現B 蛋白陽性率分別為（1）肝癌30 .4 % ( 17 / 23 ) , ( 2）肝癌合併肝硬化68.6 % ( 35 / 50 ) , （3）肝硬化8 .5 % ( 33 / 40 )，（4）慢性肝炎62 . 5 % ( 10 / 16 ) 。如以B蛋白做為肝癌之腫瘤標記，其敏感性為57. 5 % ( 42 / 43 )，特異性為25 % ( 15 / 60 )，非肝癌之其他肝疾病也可呈現血清B蛋白陽性，尤其是常合併於肝癌之肝硬化具更高比率之陽性檢驗結果，此事實更進一步限制我們於臨床上將B蛋白做為肝癌之腫瘤標記使用，且血清B 蛋白濃度和腫瘤大小及胎兒球蛋白濃度均無關連。反之在B蛋白和肝硬化之探討中，我們發現血清B蛋白濃度高低和Child 氏分類之嚴重度及病人長期預後有關，以Rank correlation ( Kendall Tau-c）計算，前者Tau-c 值為0.392 , p = 0.008 , B蛋白濃度愈高Child 氏分類愈差，後者Tau-c值為0 · 456 , p=0.021 , B蛋白濃度高者預後差。另以Survival Analysis with Covariates-Cox Model 分析Child氏分類、血清B蛋白濃度和年齡三因素對肝硬化預後之影響，發現以Child氏分類最重要，B蛋白濃度次之，而年齡因素無特別意義，如將Child氏分類之影響以計算程式控制後，B蛋白濃度之因素仍呈有意義之ratio of hazard rate ( R.R=1.4994 , p =0.018）。如以血清B蛋白濃度高低和Child氏分類來預估病人此次住院之結果，我們發現如合併考慮兩者似乎比使用任一單項更能準確的預估病人住院之結果，當病人為Child氏分類C且B蛋白濃度大於400 單位則預後甚差。由本研究我們發現B蛋白在臨床上難以當做肝癌之腫瘤標記，而血清中B蛋白濃度之高低和肝硬化病人之病況有關，它似乎可反映部份之肝損傷，而此部份可能難以單獨由Child氏分類來評估的。

並列摘要

The present studt was completed to assess the clinical utility of B protein, as a tumor marker of hepatocellular carcinoma. The association of B protein and liver cirrhosis was also evaluated because hepatocellular carcinoma is usually combined with cirrhosis. The serum levels of B protein were studied by a Latex-agglutination test. One hundred and twenty-nine patients including 23 hepatocellular carcinoma, 50 hepatocellular carcinoma combined with liver cirrhosis, 40 liver cirrhosis, and 16 chronic hepatitis were tested. The positive rates of B protein in various diseases were as follows: 30.4% (7/23) in patients with hepatocellular carcinoma; 68.6% (35/50) in patients with hepatocellular carcinoma combined with cirrhosis; 82.5% (33/40) in patients with cirrhosis; and 62.5% (10/16) in patients with chronic hepatitis. When B protein was used as a tumor marker of hepatocellular carcinoma, the sensitivity (57.5%) and specificity (25%) were very low. Furthermore, patients with hepatocellular carcinoma, usually combined with cirrhosis; which carried the highest positive rate on B protein determination. This also limited clinical utilization of B protein as a tumor marker of hepatocellular carcinoma. Moreover, there was no correlation of B protein with the serum aipha-fetoprotein level or tumor size. On the contrary, positive correlation of the B protein level with Child¡¦s staging (Tau-c value0.392, pO.OOS), and death during follow-up (Tau-c value0.456, p=O.O2l), were discovered in patients with cirrhosis. The result of¡¨ Survival Analysis with Covariates-Cox Models¡¨ calculation, B protein showed a significant ratio of hazard rate (R. R.1.4994, pO.Ol8) to patients with cirrhosis, after the variable of Child¡¦s staging was controlled by the model. We conclude that B protein can not be used as a tumor marker of hepatocellular carcinoma. It actually has some association with cirrhosis and can reflect part of liver damage which probably may not be evaluated by Child¡¦s staging only.

並列關鍵字

B protein ； hepatocellular carcinoma ； liver cirrhosis.