Waquar uddin Ahmed ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi-35. )
Sarwar J. Zuberi ( PMRC Research Centre, Jinnah Postgraduate Medical Centre, Karachi-35. )
Alpha fetoprotein (AFP) was determined using Radioimmunoassay (A IA) in 278 patients with various liver diseases. Titres were raised in hepatic malignancies as well as in other liver disorders.of AFP with age, sex, liver function tests and HBsAg No correlation was found between the titres positivity (JPMA 38: 234, 1988).
Small amounts of AFP have been detected in the sera of healthy adults with RIA1-3 indicating that the adult liver retains the capacity to make AFP in the absence of neoplastic disease, which was rarely detected before with less sensitive technique.4
Variations of AFP levels have been reported with age, type of liver disease and HBsAg positivity5-6.
The present study was conducted to determine its diagnostic value in benign and malignant liver diseases and its correlation with age, sex, liver function tests and HBs antigénemia.
PATIENTS AND METHOD
Sera of 278 patients with various liver diseases and 139 apparently healthy subjects were analysed for the presence of AFF with RIA method using Ammersham International (UK.) kit. The following tests were performed in all patients: Serum bilirubin7, alkaline phosphatase,8 SGOT and SGPT9,10. serum proteins’ seruni albumin and globulin2 and prothrombin time1
HBsAg (Countercurrent immunoelectrophoresis) was done in 140 cases. The diagnosis of various liver diseases were based on clinical and biochemical findings. Liver biopsy was done in 16% cases of hepatitis, 60% of cirrhotics and all patients with liver cancer and fatty liver. Student \'t\' test and x2 test were used for statistical analysis.
AFP was detected in 278 patients and 139 controls. Eighty controls were negative (L lng/ml) and 59 positive for AFP (rang 1-30 ng/ml).
Results are shown in Table1
Thirty-two (33.7%) of 95 cases with hepatocellular carcinoma showed AFP levels of more than 200 ng/ml. Of these 7 cases had values ranging between 160,000-320,000 ng/ml. Liver was enlarged in all cases ranging from 4-25 cm below the costal margin and all of them died within 6 months of examination. Twentyfive cases were lost to follow up. Two (18.2%) out of 11 cases of metastatic carcinoma had AFP titres more than 200 ng/ml (Figure I).
Of 48 cases of acute viral hepatitis 3(6.3%) had AFP values of more than 200 ng/ml. Maximum value attained was 560ng/ml except for one case in which exceedingly high titres 30,500 ng/ml were found. Six(6.8%) out of 88 cirrhotics had titres of more than 200 mg/mi with a maximum value of 610 ng/ml.
Titres were also elevated in some case of fatty liver, chronic persistent hepatitis and constrictive pericarditis.
Statistically no correlation was found between the titres of AFP and age, sex, liver function tests (serum biirubin, SGOT, SGPT, alkaline phosphatase), serum proteins, prothrombin time and HBsAg antigenaemia (Table II).
AFP has been detected not only in hepatic malignancies but also in cirrhosis, acute viral hepatitis and few other benign liver diseases’4.
This finding has changed the previous concepts of AFP positivity being diagnostic of hepatocellular carcinoma. Present study and few others5-14 “f show that sole positivity of AFP does not exclude other benign liver diseases. In fact high titres (200 ng/ml) or the rising titres determined by serial estimation are more diagnostic of hepatocellular carcinoma than a single reading15.
study shows similar pattern of AFP positivity in u~o.-ca acute viral hepatitis and cirrhosis. In the present study only 33.7% cases of hepatocellular carcinoma had AFP titres of more than 200 ng/ml in contrast to 100% in Singapore’ (Figure 2). Previously it was believed that AFP rises only in HBsAg positive cases5. AFP levels inthis and other series were elevated almost equally in patients with or without antigenemia16. Titers of AFP in the present study and in others17 had no relation with age, sex or any of the liver function tests, except for few in which titreswere very high in patients less than 30 years of age6-18
Previous studies showed that in hepatitis AFP levels rise when SGPT starts falling, therefore patients who fail to follow such a course have bad prognosis. 18-19 Serial estimations were not done in this study but variation in AFF titres (1—30500 ng/ml) indicate that cases were seen at various stages of the disease.
Positivity of AFP in benign liver diseases and extra hepatic diseases20 and high percentage of negativity (45.3%) in hepatocellular carcinoma in this series makes this test insignificant for the diagnosis of hepatocellular carcinoma. However, further studies with serial estimation of AFP in cirrhotics having titres of more than 200 ng/ml will help in early detection of hepatocellular carcinoma.
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