中文摘要：

目的观察原发性肝癌（PHC）患者血清微小RNA（miRNA）-29b的表达，探讨miRNA-29b和甲胎蛋白（AFP）联合检测对PHC的诊断意义。方法收集2007年1月-2010年5月温州医学院附属第-医院外科96名健康志愿者、87例住院PHC患者术前和术后血清，采用定量反转录PCR检测miRNA．29b表达量及ELISA法检测AFP含量，并分析miRNA-29b表达水平与各临床参数间的关系。结果PHC组miRNA．29b[0．250（0．124-0．381）]与健康对照组[0．860（0．587-1．338）]及PHC术后7d组[0．890（0．637～1．414）]比较，表达量明显低（P〈0．001）。PHC组AFP含量[65．4（20．1—212．3）μg/L]与健康对照组[13．3（7．1—19．8）μg／L]，及PHC术后7d组[23．2（11．6—55．7）μg／L]比较，表达量明显高（P〈0．001）。miRNA-29b表达水平与病程发展相关，分化程度越低及TNM分期越高其表达水平就越低（P〈0．045和P〈0．001）。Kaplan-Meier结果显示miRNA-29b低表达组的生存率远低于其高表达组，其中位生存期（月）分别为25．52和36．94（P=0．008）。Cox多变量分析显示miRNA．29b水平是影响PHC患者生存率的独立危险因素之一，相对危险度为0．482（95％ CI：0．236～0．985）。当ROC曲线确诊PHC的miRNA-29b临界值为0．38和AFP临界值为23．1μg/L时，PHC组血清miRNA-29b、AFP单项检测的敏感度分别为75．9％和70．1％，特异度分别为89．5％和92．7％，两者联合检测的敏感度为87．3％，特异度为88．5％。结论血清miRNA-29b的测定有助于PHC的诊断和预后的估计，联合AFP检测则可有效提高PHC诊断率。

英文摘要：

Objective To explore the clinical value of miRNA-29b expression and the combined detection of serum miRNA-29b and alpha-fetoprotein（AFP） in the diagnosis of primary hepatic carcinoma （PHC）. Methods From January 2007 to May 2010, the serum levels of miRNA-29b and AFP from 96 healthy controls and 87 PHC patients were measured by quantitative reverse transcription-polymerase chain reaction（qRT-PCR） and enzyme-linked immunosorbent assay （ELISA） respectively. The relationship of miRNA-29b and various clinical parameters was analyzed. Results Serum levels of miRNA-29b in PHC pre-operative group （ 0. 250 （ 0. 124 - 0. 381 ） ） significantly decreased versus the control group [ 0. 860 （0. 587 - 1. 338） ] and the post-operative group （0. 890（0. 637 - 1. 414） ） （P 〈0. 001 ）. Also, the levels of AFP in PHC pre-operative group （65.4 （20. 1 -212. 3 ） ） was obviously higher than that in the control group （ 13.3 （7.1 - 19. 8 ） ） and the post-operative group （23.2 （ 11.6 - 55.7 ） ） （P 〈 0. 001 ）. A lower expression of miRNA-29b was correlated with lower differentiation and higher TNM stages （P 〈 0. 045, P 〈 0. 001 ）. Kaplan-Meier curve analysis revealed that PHC patients with a low serum expression of miRNA-29b had a significantly shortened overall survival when compared with a high serum expression of miRNA-29b（25.52 vs 36. 94 months, P = 0. 008 ）. Multivariable Cox regression analysis indicated that the serum expression of miRNA-29b was an independent risk factor for overall survival. Relative risk was 0. 482 （95% confidenceinterval： 0. 236 -0. 985）. The critical values for miRNA-29b and AFP were determined at 0. 38 and 23.1 μg/L through the ROC curves. Under the critical value, the sensitivity of miRNA-29b and AFP were 75.9% and 70. 1% and the specificity of miRNA-29b and AFP 89. 5% and 92. 7% respectively. Combined detection could increase the sensitivity up to 87.3%, and achieve a specificity of 88.5% . Conclusion The combined detectio