小児期固形腫蕩の診断における腫蕩マーカーの役割 : マススクリーニングの現状と展望について

最近， 悪性腫瘍の診断は， CT， MRI 等による画像診断の発達と各種腫瘍マーカーの進歩により以前とは少し異なった様相を呈している。臨床家にとって少量の血液を採取し， それを測定することによって悪性腫瘍を迅速かつ正確に診断する腫瘍マーカーの開発は理想であるが， 乳幼児を対象とする小児科医では， 生検や画像診断に制限があり， また採血が困難で、採血量にも限りがある事から， さらにその願望が強いと思われる。現状の腫傷マーカーの精度や感度を考えると理想には程遠いと言わざるを得ないが， 各種腫瘍マーカー測定の組合せや新しいマーカーの開発などにより， 一歩でも理想に近づこうとする努力が続けられている。本稿では小児科領域における腫瘍マーカーの現状と， それを応用し， 不特定多数の乳幼児を対象とした神経芽細胞腫の早期発見を目指すマススクリーニングの展望につき検討する

C型肝硬変症例における肝細胞癌の発生に対するインターフェロン治療の効果

　Interferon (IFN) has been widely used as an useful antiviral agent for HCV-related chronic hepatitis patients to block the development to cirrhosis which often complicates hepatocellular carcinoma (HCC). However, its efficacy for cirrhotic patients is still equivocal. In 63 patients with HCV-related cirrhotic patients, the effect of IFN therapy on the occurrence of HCC was evaluated. The patients were allocated into IFN-therapy group and control group according to patients\u27 will. IFN-α or IFN-β was basically administered for 6 months or 6 weeks at various doses. There was no difference in demographic and clinical features between both groups. HCC occurred in 6 of 39 patients (15%) in the IFN-therapy group during the observation period (IFN group ; 44.0±5.3 months, Control group ; 42.4±5.0 months) but in 9 of 24 patients (38%) in the control group (p＜0.05). The survival rate was also significantly improved in the IFN-therapy group. There were 7 of the 39 IFN-therapy group patients who showed sustained normal levels of serum GPT activity and no detectable HCV-RNA, but none of the control group patients (p＜0.05). In these patients of the IFN-therapy group, serum albumin levels and platelet and WBC counts were significantly higher at the end of the observation period than before the IFN therapy, but such increases were not seen in the IFN-therapy group patients who did not show normalization in serum GPT activity and HCV-RNA. Cox\u27s multi-variate regression analysis revealed that alcohol intake, serum HCV-RNA levels and IFN therapy were significant factors related to the HCC occurrence in both groups. There were two patients who developed complications associated with the IFN therapy, but completely reversed after its discontinuation. In conclusion, IFN therapy may be an advisable candidate for HCV-related cirrhotic patients whose serum HCV-RNA levels were rather low to block the occurrence of HCC