评价与探讨血清人黑色素瘤细胞黏附分子(melanoma cell adhesion molecule, MCAM)在肝细胞肝癌(hepatocellular carcinoma，HCC)中的表达及其诊断HCC的价值。

采用酶联免疫吸附试验(enzyme-linked immunosorben assay, ELISA)检测2013年11月至2015年2月在上海市第十人民医院和瑞金医院住院的83例HCC患者和85名健康人血清MCAM、白细胞分化抗原(cluster of differentiation, CD)₁₆₆水平，并用Spearman分析MCAM与丙氨酸氨基转移酶(alanine aminotransferase，ALT)、天冬氨酸氨基转移酶(aspartate aminotransferase，AST)、碱性磷酸酶(alkaline phosphatase，ALP)、γ-谷氨酰转肽酶(γ-glutamyl transpeptidase，γ-GT)、胆汁酸(total bile acid，TBA)、总蛋白(total protein, TP)、甲胎蛋白(alpha fetal protein，AFP)诊断HCC的相关性；同时，通过受试者工作特征(receiver operating characteristic, ROC)曲线评价MCAM诊断HCC的特异度和敏感度。

血清MCAM、CD₁₆₆、AFP在健康对照组分别为(2 776.8±25.8)ng/L、(222.6±74.9) ng/L、(21.7±9.6) μg/L，在HCC组分别为(20 453.3±110.2) ng/L、(5 702.0±99.0) ng/L、(275.7±83.4) μg/L。两组的MCAM与CD₁₆₆或MCAM与AFP均相关(r值分别为0.875、0.858，P均<0.001)。HCC组中γ-GT、TBA、ALP、ALT、AST、TP分别为(120.8±10.0)IU/L、(123.6±24.8)μmol/L、(158.2±15.4)IU/L、(69.3±8.3)IU/L、(135.7±12.8)IU/L、(67.3±8.7) μg/L。经Spearman分析，血清MCAM升高与CD₁₆₆升高和肝功能降低(ALT、AST、ALP、γ-GT、TBA)均呈正相关(r值分别为0.875、0.407、0.831、0.456、0.670、0.685，P均<0.001)。以血清MCAM的ROC曲线下面积(area under curve，AUC)0.940，确定其最佳临界值为2 397.6 μg/L时，诊断HCC的敏感度为90.4%(152/168例)，特异度94.1%(158/168例)；血清MCAM、CD₁₆₆和AFP联合检测HCC的ROC曲线的AUC为0.984(95%CI 0.969~1.000)、敏感度为98.8%(160/168例)、特异度为94.1%(158/168例)。AFP、MCAM单项检测和MCAM联合CD₁₆₆检测的ROC曲线的AUC、敏感度和特异度分别为0.931(95%CI 0.887~0.974)、89.2%(150/168例)、94.1%(158/168例), 0.940(95%CI 0.900~0.981)、90.4%(152/168例)、94.1%(158/168例)，0.976(95%CI 0.955~0.998)、97.6%(164/168例)、92.9%(156/168例)。

血清MCAM诊断HCC具有高敏感度和特异度，有能可成为诊断HCC的新指标，但需扩大样本量进行严格验证。AFP、MCAM单项检测和MCAM联合CD₁₆₆检测都对辅助诊断HCC有临床应用价值。

To explore the expression characteristic of serum melanoma cell adhesion molecule (MCAM) in patients with hepatocellular carcinoma (HCC), evaluate the clinical significance of candidate MCAM in thediagnosis of HCC.

Eighty-three HCC patients and eighty-five healthy individuals at Shanghai Ruijin Hospital and Shanghai Tenth People’s Hospital from November 2013 to February 2015 were considered eligible for this study. Serum MCAM and cluster of differentiation (CD)₁₆₆ were examined using enzyme-linked immunosorben assay(ELISA). Analysis the relationship between MCAM and those seven indexes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (γ-GT), total bileacid (TBA), total protein (TP) and alpha fetal protein (AFP) by using spearman. Meanwhile, to evaluate the specificity and sensitivity of MCAM in the diagnosisof HCC through the receiver-operating characteristics curve.

Serum MCAM, serum CD₁₆₆, AFP of healthy individuals were (2 776.7±25.8) ng/L, (222.6±74.9) ng/L, (21.7±9.6) μg/L and those of patients with HCC were (20 453.3±110.2) ng/L, (5 702.0±99.0) ng/L, (275.7±83.4) μg/L. A positivecorrelation was found between serum MCAM and CD₁₆₆(r=0.875, P<0.001). Besides, a positivecorrelation was also found between serum MCAM and AFP(r=0.858, P<0.001). In patients with HCC, the data of γ-GT, TBA, ALP, ALT, AST and TP were collected as follows: (120.8±10.0) IU/L, (123.6±24.8) μmol/L, (158.2±15.4) IU/L, (69.3±8.3) IU/L, (135.7±12.8) IU/L, (67.3±8.7) μg/L. Serum MCAM was also positively correlated with CD₁₆₆, ALT, AST, ALP, γ-GT TBA(r of 0875, 0.407, 0.831, 0.456, 0.670, 0.685, P<0.001). The areaunder the receiver operating characteristic curve for serum-MCAM was 0.940, for the differentiation of HCC patients from healthy individualswith a cut-off of 2 397.6 μg/L, sensitivity 90.4% (152/168), specificity 94.1%(158/168). AUC-ROC also indicated that the combination of MCAM and CD₁₆₆ with AFP(0.984, 95%CI 0.969-1.000), sensitivity 98.8% (160/168), specificity 94.1% (158/168) to diagnose HCC was only slightly better than AFP (0.931, 95%CI 0.887-0.974), sensitivity 89.2% (150/168), specificity 94.1% (158/168) or MCAM (0.940(95% CI 0.900-0.981), sensitivity 90.4% (152/168), specificity 94.1% (158/168) alone or the combination of MCAM and CD₁₆₆ (0.976, 95% CI 0.955-0.998), sensitivity 97.6% (164/168), specificity 92.9% (156/168).

Serum MCAM is a novel diagnostic tumor marker for HCC. With high sensitivity and specificity, MCAM could have a good diagnostic efficiency as a novel hepatocellular carcinoma tumor marker in the near future. But this still need to expand the sample size to further verification. The single examination of AFP, MCAM or the combination of MCAM with CD₁₆₆ are all hetpful for diagnosis of HCC in clinical application.