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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。
Objective: To investigate the micrometastasis in peripheral blood of patients with hepatocellular carcinoma and its clinical significance. METHODS: Nested-RT-PCR was used to detect 65 cases of hepatocellular carcinoma, 21 cases of non-hepatoma malignancies, 22 cases of chronic hepatitis B or cirrhosis, and 21 healthy volunteers. Alpha-fetoprotein (AFP) mRNA in peripheral venous blood. Results: AFP-mRNA was negative in peripheral blood of healthy volunteers and non-hepatocarcinoma patients. The detection rate of AFP-mRNA in the peripheral blood of hepatocellular carcinoma group was significantly higher than that of the other groups (67.7%, 44/65). Chronic hepatitis B or cirrhosis group (9.1%, 2/22, P<0.01). The detection rate of AFP-mRNA was significantly associated with clinical stage, portal vein tumor embolus, and extrahepatic metastasis. After 1 year of follow-up, it was found that the positive AFP-mRNA in the peripheral blood after treatment was significantly associated with the prognosis of patients with liver cancer. In 12 cases of liver cancer patients with serum AFP <25μg/L, 7 cases (58. 3%) could detect AFP-mRNA. Conclusion: AFP-mRNA can be used as a marker of liver cancer cells or hepatocytes in the blood circulation. In patients with liver cancer, positive predictive of blood-borne metastasis may be used as a reference index for predicting recurrence and metastasis of liver cancer; and AFP-mRNA pair serum AFP-negative or low-value liver cancer patients can play a complementary diagnostic role.