ヒト絨毛性ゴナドトロピン human chorionic gonadotropin
出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2013/12/04 04:55:01」(JST)
ヒト絨毛性ゴナドトロピン(-じゅうもうせい-、Human chorionic gonadotropin, hCG)とは、妊娠中に産生されるホルモンである。
ヒト絨毛性ゴナドトロピンは、受胎の直後から胎児の栄養膜合胞体層(胎盤の一部)で作られる。その役割は卵巣にある黄体の分解を防いで、ヒトの妊娠に重要であるプロゲステロンの産生を保たせる。hCGの別の働きに、例えば母児免疫寛容へ影響していると考えられている。早期の妊娠検査はhCGの検出や測定によるものである。
Pregnyl®、Follutein®、Ovidrel®といった薬品(いずれも日本国外での商品名。日本では『ゴナトロピン®』など多数)は有効成分に絨毛性ゴナドトロピンを使っている。これらの製剤は排卵を誘発する黄体形成ホルモンの代わりに補助受胎(ART、いわゆる不妊治療)で使われる。
hCGは237のアミノ酸からなる36.7kDaの糖タンパク質であり、また、黄体形成ホルモン(LH)、卵胞刺激ホルモン(FSH)、甲状腺刺激ホルモン(TSH)と同一のαサブユニットと独自のβサブユニットからなるヘテロダイマーである。
hCGは黄体の保持を促進し、それにホルモンのプロゲステロンを分泌させる。プロゲステロンは子宮の内側を血管で肥厚させ胎児の成長ができるようにする。
LHとFSHとの類似性により、hCGもまた臨床的に卵巣では排卵、そして精巣ではテストステロン産生を誘発することができる。最も豊富な生物学的資源としては妊娠している女性があり、いくつかの団体では妊婦から尿を集めhCGを抽出して不妊治療へ役立てている。
妊娠検査ではhCGの血中または尿中レベル計測して受精卵の有無を示す。特に、殆どの妊娠検査ではhCGのβサブユニット(βhCG)に特異的な抗体を用いる。検査で重要なのはhCGがLHやFSHと混乱して擬陽性の出ないことである。(後者の2つは体内で異なったレベルで存在しているのに対し、hCGは妊娠中を除き無視できるレベルである。)尿検査は25~100mIU/mlを検出できるクロマトグラフィーの免疫測定法である。尿はhCGレベルの高い朝の最初の尿でなくてはならない。もし尿の比重が1.015を越えていた場合、尿は薄める。血清検査では2~4mlの静脈血を用い、βhCGを5mIU/mlを検出でき、その濃度を定量可能な放射性免疫測定法(RIA)である。βhCGの定量できることは子宮外妊娠かどうかを見たり、胚細胞腫瘍や栄養膜腫瘍を監視するのに便利である。
胞状奇胎では胚が存在しないのに高濃度のβhCGが産生されるため、妊娠検査で擬陽性を出す。
βhCGはまた、奇形腫、絨毛がん、島細胞腫瘍などのいくつかのがんから分泌される。奇形腫(大抵は精巣と卵巣で見つかるが未分化胚細胞腫として脳でもみられる)を持っている疑いのある患者の場合、外科医はβhCGの測定を考えるだろう。上昇した水準が腫瘍の存在を証明することはできず、低い水準がそれを排除することもない。にも関わらず、上昇したβhCG水準は順調な治療(例えば外科手術や化学療法)の後に低下し、再発はその水準の上昇により検出される。
hCGは様々な蛋白同化ステロイド(Anabolic Androgenic Steroid, AAS)サイクルと組み合わされてドーピングへ用いられている。AASが男性の体へ入ると、体は自然に負のフィードバックが作動して自らのテストステロンをHPTA(視床下部下垂体甲状腺軸)を通してシャットダウンする。天然のテストステロンに擬態した高レベルのAASの類は脳下垂体へその性腺刺激ホルモン放出ホルモン(GnRH)の産生をシャットダウンする。GnRHがないと下垂体は黄体形成ホルモン(LH)の分泌を停止される。LHは通常、下垂体から血流に乗って精巣へ行きテストステロンの産生と分泌の引き金を引く。LHがないと、精巣はそのテストステロン産生をシャットダウンし、精巣は萎縮する。男性ではhCGはLHに擬態して精巣内のテストステロンの回復・保持を補助する。そのため、hCGは通常、ステロイドサイクル中や後に精巣のサイズ、そして自身のテストステロン産生を保持・回復するために使用される。
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Chorionic Gonadotropin, alpha polypeptide |
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Identifiers | |
Symbol | CGA |
Alt. symbols | FSHA, GPHa, GPHA1, HCG, LHA, TSHA |
Entrez | 1081 |
HUGO | 1885 |
OMIM | 118850 |
RefSeq | NM_000735 |
UniProt | P01215 |
Other data | |
Locus | Chr. 6 q14-q21 |
chorionic gonadotropin, beta polypeptide |
|
---|---|
Identifiers | |
Symbol | CGB |
Alt. symbols | CGB3 |
Entrez | 1082 |
HUGO | 1886 |
OMIM | 118860 |
RefSeq | NM_000737 |
UniProt | P01233 |
Other data | |
Locus | Chr. 19 q13.3 |
In molecular biology, human chorionic gonadotropin (hCG) is a hormone produced by the syncytiotrophoblast, a component of the fertilized egg, after conception. Following implantation, the syncytiotrophoblast gives rise to the placenta.[1][2] Some cancerous tumors produce this hormone; therefore, elevated levels measured when the patient is not pregnant can lead to a cancer diagnosis. However, it is not known whether this production is a contributing cause or an effect of tumorigenesis. The pituitary analogue of hCG, known as luteinizing hormone (LH), is produced in the pituitary gland of males and females of all ages.[1][3] As of December 6, 2011 (2011-12-06)[update], the United States FDA has prohibited the sale of "homeopathic" and over the counter hCG diet products and declared them fraudulent and illegal.[4][5][6]
Human chorionic gonadotropin is a glycoprotein composed of 237 amino acids with a molecular mass of 25.7 kDa.[7]
It is heterodimeric, with an α (alpha) subunit identical to that of luteinizing hormone (LH), follicle-stimulating hormone (FSH), thyroid-stimulating hormone (TSH), and β (beta) subunit that is unique to hCG.
The two subunits create a small hydrophobic core surrounded by a high surface area-to-volume ratio: 2.8 times that of a sphere. The vast majority of the outer amino acids are hydrophilic.[7]
Human chorionic gonadotropin interacts with the LHCG receptor and promotes the maintenance of the corpus luteum during the beginning of pregnancy. This allows the corpus luteum to secrete the hormone progesterone during the first trimester. Progesterone enriches the uterus with a thick lining of blood vessels and capillaries so that it can sustain the growing fetus. Due to its highly negative charge, hCG may repel the immune cells of the mother, protecting the fetus during the first trimester. It has also been hypothesized that hCG may be a placental link for the development of local maternal immunotolerance. For example, hCG-treated endometrial cells induce an increase in T cell apoptosis (dissolution of T cells). These results suggest that hCG may be a link in the development of peritrophoblastic immune tolerance, and may facilitate the trophoblast invasion, which is known to expedite fetal development in the endometrium.[10] It has also been suggested that hCG levels are linked to the severity of morning sickness in pregnant women.[11]
Because of its similarity to LH, hCG can also be used clinically to induce ovulation in the ovaries as well as testosterone production in the testes. As the most abundant biological source is women who are presently pregnant, some organizations collect urine from pregnant women to extract hCG for use in fertility treatment.[12][13]
Human chorionic gonadotropin also plays a role in cellular differentiation/proliferation and may activate apoptosis.[14]
Like other gonadotropins, it can be extracted from the urine of pregnant women or extracted from cultures of genetically modified microbes with recombinant DNA.
In Pregnyl, Follutein, Profasi, Choragon and Novarel, it is extracted from pregnant urine. In Ovidrel, it is protein expressed by microbes with recombinant DNA.
Naturally, it is produced in the placenta by the syncytiotrophoblast.
Total hCG, C-terminal peptide total hCG, intact hCG, free β-subunit hCG, β-core fragment hCG, hyperglycosylated hCG, nicked hCG, alpha hCG, pituitary hCG.
Blood or urine tests measure hCG. These can be pregnancy tests. hCG-positive indicates an implanted blastocyst and mammalian embryogenesis. These can be done to diagnose and monitor germ cell tumors and gestational trophoblastic diseases.
As pregnancy tests, quantitative blood tests and the most sensitive urine tests usually detect hCG between 6 and 12 days after ovulation.[15] However, it must be taken into account that total hCG levels may vary in a very wide range within the first 4 weeks of gestation, leading to false results during this period of time.[16]
Gestational trophoblastic disease like hydatidiform moles ("molar pregnancy") or choriocarcinoma may produce high levels of βhCG (due to the presence of syncytialtrophoblasts- part of the villi that make up the placenta) despite the absence of an embryo. This, as well as several other conditions, can lead to elevated hCG readings in the absence of pregnancy.
hCG levels are also a component of the triple test, a screening test for certain fetal chromosomal abnormalities/birth defects.
Most tests employ a monoclonal antibody, which is specific to the β-subunit of hCG (β-hCG). This procedure is employed to ensure that tests do not make false positives by confusing hCG with LH and FSH. (The latter two are always present at varying levels in the body, whereas the presence of hCG almost always indicates pregnancy.)
Many hCG immunoassays are based on the sandwich principle, which uses antibodies to hCG labeled with an enzyme or a conventional or luminescent dye. Pregnancy urine dipstick tests are based on the lateral flow technique.
Concentrations are commonly reported in thousandth international units per milliliter (mIU/ml). The international unit of HCG was originally established in 1938 and has been redefined in 1964 and in 1980.[20] At the present time, 1 international unit is equal to approximately 2.35×10−12 moles,[21] or about 6×10−8 grams.[22]
The following is a list of serum HCG levels. (LMP is the last menstrual period dated from the first day of your last period.) The levels grow exponentially after conception and implantation.
weeks since LMP | mIU/mL |
---|---|
3 | 5 – 50 |
4 | 5 – 426 |
5 | 18 – 7,340 |
6 | 1,080 – 56,500 |
7 – 8 | 7,650 – 229,000 |
9 – 12 | 25,700 – 288,000 |
13 – 16 | 13,300 – 254,000 |
17 – 24 | 4,060 – 165,400 |
25 – 40 | 3,640 – 117,000 |
Non-pregnant females | <5.0 |
Postmenopausal females | <9.5 |
Human chorionic gonadotropin can be used as a tumor marker, as its β subunit is secreted by some cancers including seminoma, choriocarcinoma, germ cell tumors, hydatidiform mole formation, teratoma with elements of choriocarcinoma, and islet cell tumor. For this reason a positive result in males can be a test for testicular cancer. The normal range for men is between 0-5 mIU/mL. Combined with alpha-fetoprotein, β-HCG is an excellent tumor marker for the monitoring of germ cell tumors.[citation needed]
Clinical data | |
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Trade names | Novarel, Pregnyl |
AHFS/Drugs.com | monograph |
Pregnancy cat. | ? |
Legal status | ? |
Identifiers | |
CAS number | 9002-61-3 Y |
ATC code | G03GA08 |
DrugBank | DB00097 |
Chemical data | |
Formula | C1105H1770N318O336S26 |
Mol. mass | 25719.70 |
N (what is this?) |
Human chorionic gonadotropin is extensively used parenterally as an ovulation inducer in lieu of luteinizing hormone. In the presence of one or more mature ovarian follicles, ovulation can be triggered by the administration of HCG. As ovulation will happen between 38 and 40 hours after a single HCG injection,[23] procedures can be scheduled to take advantage of this time sequence,[24] such as intrauterine insemination or sexual intercourse. Also, patients that undergo IVF, in general, receive HCG to trigger the ovulation process, but have an oocyte retrieval performed at about 34 to 36 hours after injection by, a few hours before the eggs actually would be released from the ovary.
As HCG supports the corpus luteum, administration of HCG is used in certain circumstances to enhance the production of progesterone.
In the male, HCG injections are used to stimulate the leydig cells to synthesize testosterone. The intratesticular testosterone is necessary for spermatogenesis from the sertoli cells. Typical uses for HCG in men include hypogonadism and fertility treatment.
During first few months of pregnancy, the transmission of HIV-1 from woman to fetus is extremely rare. It has been suggested that this is due to the high concentration of HCG, and that the beta-subunit of this protein is active against HIV-1.[25]
In the case of female patients who want to be treated with HCG Pregnyl:[26] a) Since infertile female patients who undergo medically assisted reproduction (especially those who need in vitro fertilization), are known to often be suffering from tubal abnormalities, after a treatment with this drug they might experience many more ectopic pregnancies. This is why early ultrasound confirmation at the beginning of a pregnancy (to see whether the pregnancy is intrauterine or not) is crucial. - Pregnancies that have occurred after a treatment with this medicine are submitted to a higher risk of multiplets. - Female patients who have thrombosis, severe obesity or thrombophilia should not be prescribed this medicine as they have a higher risk of arterial or venous thromboembolic events after or during a treatment with HCG Pregnyl. b)Female patients who have been treated with this medicine are usually more prone to pregnancy losses.
In the case of male patients: A prolonged treatment with HCG Pregnyl is known to regularly lead to increased production of androgen. Therefore: Patients who are suffering from overt or latent cardiac failure, hypertension, renal dysfunction, migraines or epilepsy might not be allowed to start using this medicine or may require a lower dose of HCG Pregnyl. Also this medicine should be used with extreme caution in the treatment of prepubescent teenagers in order to reduce the risk of precocious sexual development or premature epiphyseal closure. This type of patients' skeletal maturation should be closely and regularly monitored.
Both male and female patients who have the following medical conditions must not start a treatment with HCG Pregnyl: (1) Hypersensitivity to this medicine or to any of its main ingredients. (2) Known or possible androgen-dependent tumors for example male breast carcinoma or prostatic carcinoma.
In the world of performance-enhancing drugs, HCG is increasingly used in combination with various anabolic androgenic steroid (AAS) cycles. As a result, HCG is included in some sports' illegal drug lists.
When exogenous AAS are put into the male body, natural negative-feedback loops cause the body to shut down its own production of testosterone via shutdown of the hypothalamic-pituitary-gonadal axis (HPGA). This causes testicular atrophy, among other things. HCG is commonly used during and after steroid cycles to maintain and restore testicular size as well as normal testosterone production.[27]
High levels of AASs, that mimic the body's natural testosterone, trigger the hypothalamus to shut down its production of gonadotropin-releasing hormone (GnRH) from the hypothalamus. Without GnRH, the pituitary gland stops releasing luteinizing hormone (LH). LH normally travels from the pituitary via the blood stream to the testes, where it triggers the production and release of testosterone. Without LH, the testes shut down their production of testosterone.[28] In males, HCG helps restore and maintain testosterone production in the testes by mimicking LH and triggering the production and release of testosterone.
If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary gland.[citation needed]
Professional athletes who have tested positive for HCG have been temporarily banned from their sport, including a 50-game ban from MLB for Manny Ramirez in 2009[29] and a 4-game ban from the NFL for Brian Cushing for a positive urine test for HCG.[30]
British endocrinologist Albert T. W. Simeons' proposed HCG as an adjunct to an ultra-low-calorie weight-loss diet (less than 500 calories).[31] Simeons, while studying pregnant women in India on a calorie-deficient diet, and "fat boys" with pituitary problems (Frölich's syndrome) treated with low-dose HCG, claimed that both lost fat rather than lean (muscle) tissue.[citation needed] He reasoned that HCG must be programming the hypothalamus to do this in the former cases in order to protect the developing fetus by promoting mobilization and consumption of abnormal, excessive adipose deposits. Simeons in 1954 published a book entitled Pounds and Inches, designed to combat obesity. Simeons, practicing at Salvator Mundi International Hospital in Rome, Italy, recommended low-dose daily HCG injections (125 IU) in combination with a customized ultra-low-calorie (500 cal/day, high-protein, low-carbohydrate/fat) diet loss of adipose tissue without loss of lean tissue.[citation needed]
Simeons' results were not reproduced by other researchers and in 1976 in response to complaints the FDA required Simeons and others to include the following disclaimer on all advertisements:
These weight reduction treatments include the injection of HCG, a drug which has not been approved by the Food and Drug Administration as safe and effective in the treatment of obesity or weight control. There is no substantial evidence that HCG increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restrictive diets.
— 1976 FDA-mandated disclaimer for HCG diet advertisements
There was a resurgence of interest in the "HCG diet" following promotion by Kevin Trudeau who was later banned from making HCG diet weight-loss claims by the U.S. Federal Trade Commission.[32]
Review studies refuting the HCG diet have been published in the Journal of the American Medical Association and the American Journal of Clinical Nutrition,[33] both concluding that HCG is neither safe nor effective as a weight-loss aid.[34]
A meta analysis found that studies supporting HCG for weight loss were of poor methodological quality and concluded that "there is no scientific evidence that HCG is effective in the treatment of obesity; it does not bring about weight-loss or fat-redistribution, nor does it reduce hunger or induce a feeling of well-being".[35]
There is no scientific evidence that HCG is effective in the treatment of obesity. The meta-analysis found insufficient evidence supporting the claims that HCG is effective in altering fat-distribution, hunger reduction or in inducing a feeling of well-being. The authors stated “…the use of HCG should be regarded as an inappropriate therapy for weight reduction…” In the authors opinion, “Pharmacists and physicians should be alert on the use of HCG for Simeons therapy. The results of this meta-analysis support a firm standpoint against this improper indication. Restraints on physicians practicing this therapy can be based on our findings.”
— American Society of Bariatric Physicians'[36] commentary on Lijesen et. al (1995)[35]
According to the American Society of Bariatric Physicians, no new clinical trials have been published since the definitive 1995 meta-analysis.[36]
The scientific consensus is that any weight loss reported by individuals on an "HCG diet" may be attributed entirely to the fact that such diets prescribe calorie intake of between 500 and 1,000 calories per day, substantially below recommended levels for an adult, to the point that this may risk health effects associated with malnutrition.[37]
Controversy about, and shortages[38] of, injected HCG for weight loss have led to substantial Internet promotion of "homeopathic HCG" for weight control. The ingredients in these products are often obscure, but if prepared from true HCG via homeopathic dilution, they contain either no HCG at all or only trace amounts.
The United States Food and Drug Administration has stated that over-the-counter products containing HCG are fraudulent and ineffective for weight loss. They are also not protected as homeopathic drugs and have been deemed illegal substances.[39][40] HCG itself is classified as a prescription drug in the United States and it has not been approved for over-the-counter sales by the FDA as a weight loss product or for any other purposes, and therefore neither HCG in its pure form nor any preparations containing HCG may be sold legally in the country except by prescription.[4] In December 2011, FDA and FTC started to take actions to pull unapproved HCG products from the market.[4] In the aftermath, some suppliers started to switch to "hormone-free" versions of their weight loss products, where the hormone is replaced with an unproven mixture of free amino acids[41] or where radionics is used to transfer the "energy" to the final product.
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国試過去問 | 「098C010」「096I033」「112A056」「108I045」「105G052」「110D029」「098I028」「096D041」「113A045」「100I014」「112D048」「099D102」「109B034」「097B034」「097B008」「107B017」「096H058」「106E024」「088B001」「077A013」 |
リンク元 | 「卵巣癌」「腫瘍マーカー」「甲状腺ホルモン」「子宮外妊娠」「ヒト絨毛性ゴナドトロピン」 |
拡張検索 | 「hCG receptor」「hCG-beta」「hMG-hCG試験」「異所性hCG産生腫瘍」「hCG-CTP」 |
関連記事 | 「HCG」 |
BD
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C
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CD
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C
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・予後:治療しなければ予後不良。増殖速度は中等度でリンパ節転移しやすい。
・予後:容易。進行遅く、転移も少ない。
名称 | 卵巣癌の中の頻度 | 疫学 | 病理 | 類似性 | 予後 | 卵巣チョコレート嚢胞 との関連 |
漿液性腺癌[漿液性嚢胞腺癌] | 50% | 平均55歳 | 小型で細胞質に乏しい。樹枝状に分枝。乳頭状腺癌 | 卵巣表皮上皮、卵管上皮細胞 | 比較的良好 | |
粘液性腺癌[粘液性嚢胞腺癌] | 10-15% | 平均44歳 | 豊富な粘液をもつ多房構造や15cmを超える巨大腫瘤 | 子宮頸部粘膜上皮 腸上皮に類似 |
抗癌剤感受性低く、進行癌は予後不良 | |
類内膜腺癌 | 10-15% | 非妊時子宮内膜に類似 | ○ | |||
明細胞腺癌 | 15-20% | 子宮内膜症合併 | 胞体は明るくグリコーゲンに富む。 | 妊娠子宮内膜に類似 嚢胞乳頭状構造 |
プラチナ感受性悪く予後不良 | ○ |
名称 | AFP | CA125 | CA72-4 | BFP | CEA |
漿液性腺癌[漿液性嚢胞腺癌] | ○ | ○ | |||
粘液性腺癌[粘液性嚢胞腺癌] | ○ | ||||
類内膜腺癌 | ○ | ||||
明細胞腺癌 | |||||
卵黄嚢腫瘍 | ○ | ||||
転移性卵巣癌 | ○ | ○ |
CA125 | 漿液性嚢胞腺癌 | 類内膜腺癌 | 移行上皮癌 | |
CEA | CA19-9 | 粘液性嚢胞腺癌 | ||
エストロゲン | 顆粒膜細胞腫 | 莢膜細胞腫 | ||
アンドロゲン | セルトリ・間質細胞腫 | ライディッヒ細胞種 | ||
CA19-9 | SCC | 奇形腫 | ||
AFP | 卵黄嚢腫瘍 | 胎芽性癌 | ||
hCG | 絨毛癌 | 胎芽性癌 | 未分化胚細胞腫 | |
LDH | 未分化胚細胞腫 | |||
CEA | クルケンベルグ腫瘍 |
陽性率(疾患があるときに陽性となる確率, 感度) | ||||||
肺癌 | 備考 | |||||
扁平上皮癌 | 腺癌 | 小細胞癌 | その他の疾患 | |||
CYFRA21-1 | 57.5%* | 70-80%/73.1%* | 30-40% | 30-40% | 良性疾患:10-15% | |
SCC | ○ | 子宮頸癌、食道癌、皮膚癌 | ||||
CEA | 40-50% | 50-60% | ||||
SLX | 70%* | 0.4 | 肝硬変 | |||
NSE | 10-30% | 70-90% | ||||
proGRP | 70-90%/65.1%* | NSEより上昇率が高く、特異性に優れる | ||||
KL-6 | ○ | 肺腺癌、膵癌、乳癌で40-50%。間質性肺炎の補助診断 | ||||
無印:標準呼吸器病学 第1版 p.327。* 臨床検査学第32版 p.634 |
肝癌関連 AFP, AFP-L3%, PIVKA-II 膵癌ならびにその他の消化器癌 CEA, CA19-9, Dupan-2, CA50, Span-1 肺癌 CEA, sialyl Lex-i (SLX), SCC, SYFRA21-1, NSE, ProGRP 婦人科悪性腫痩 子宮癌:SCC, CA125 卵巣癌:CA125, AFP, CEA, CA19-9, GAT 乳癌 :CA15-3, BCA225, CEA, NCC-ST-439 尿器科悪性腫壕 前立腺痛:PSA(γ-Sm), PAP 膀胱癌 :BTA, NMP22 神経内分泌腫療 NSE 広範な腫瘍に反応するマーカー TPA, BFP, IAP
AFP | 肝細胞癌、肝芽腫、卵黄脳腫瘍 |
CEA | 消化器系の癌、肺癌、乳癌(腺癌の頻度が高く、臓器特異性は低い) |
CA19-9 | 胆道系の癌、膵癌 |
CA125 | 卵巣癌 |
CA15-3 | 乳癌、卵巣癌 |
PIVKA-II | 肝細胞癌 |
PSA | 前立腺癌 |
上皮性腫瘍 漿液性腺癌: CA125 *1 粘液性腺癌: CA19-9 *2, CA72-4, CEA 胚細胞腫瘍 卵黄嚢腫瘍: AFP *3 絨毛癌: hCG 未分化胚細胞腫: LDH *4 悪性転化を伴う成熟嚢胞性奇形腫(扁平上皮癌) : SCC 性索間質性腫瘍(ホルモン) 顆粒膜細胞腫,莢膜細胞腫:工ストロゲン Sertoli-間質性腫瘍, Leydig細胞腫(門細胞腫) :テストステロン *1 上皮性腫瘍中で最も有用.類内膜腺癌,明細胞腺癌でも陽性を示す.子宮内膜症,炎症,妊娠初期も軽度-中等度上昇 *2 成熟嚢胞性奇形腫で陽性を示すことがある *3 胎芽性癌,混合性腔細胞腫療でも陽性を示す *4 非特異的
(略)
.