Laminin and Chromogranin A as Serum Markers of Liver Fibrosis in Hepatocellular Carcinoma

摘要

Cirrhosis of the liver is the most important risk factor for hepatocellular carcinoma (HCC), which represents the leading cause of death in these patients. The most useful serum marker of the tumor, alpha-fetoprotein (AFP), has a highly variable sensitivity and specificity in the reported studies. Laminin (Ln) is a glycoprotein which has an important role in the mechanism of fibrogenesis and is, thus, related to hepatic fibrosis in addition to presenting increased levels in several types of neoplasias. Elevated Chromogranin-A(CgA) in patients with cirrhosis and superimposed HCC suggesting that raising CgA levels, likely due to a neuroendocrine component of the tumor, might be a useful prognostic marker for HCC in cirrhotic patients. Aim of the work: The objective of the present study is to determine the relationship between laminin and chromogranin- A in plasma of patients with hepatocellular carcinoma in order to determine whether laminin and chromogranin- A may serve as markers for liver fibrosis and whether these parameters could be correlate with liver functions of these patients Subjects and methods: This study was conducted on 50 Egyptian subjects and classified into two groups: Thirty patients of hepatocellular carcinoma (HCC) with previous history of hepatitis C group(G II) (n = 30), in addition to twenty age and sex matched healthy individuals as a control group(GI). HCC was diagnosed histologically or by imaging. They were recruited from the outpatient clinic of Internal Medicine Department of Al-Zaharaa University Hospital, Cairo, Egypt. Liver function tests (AST, ALT, GGT, total bilirubin and albumin) by colorimetric assay, Plasma Laminin and chromogranin-A (by ELISA) and alpha fetoprotein (by immunometric assay) were estimated. Results: laminin and CgA levels were significantly higher in group II (HCC patients) when compared to group I (control subjects) (p<0.0001). Statistically significant positive correlation between CgA versus Ln at HCC group (p< 0.0001). Statistically significant positive correlation between CgA versus GGT (p=0.001) and Ln versus GGT at HCC group (p< 0.0001). CgA level shows best cut off 106 (ng/ml) and Ln level shows best cut off 1065 (ng/ml) and CgA and Ln levels shows %100 sensitivity and %100 specificity in HCC group, which proof that both markers are considered high validity tests in prediction of HCC and hepatic cirrhosis. Conclusions: Laminin and CgA represent useful diagnostic as well as prognostic biomarkers for liver cirrhosis and HCC.