摘要
目的 探讨在有肝实质占位病变 (spaceoccupinglesion ,SOL)时甲胎蛋白 (AFP)低浓度阳性 (AFP 2 1～ 2 0 0 μg/L)肝细胞癌 (HCC)患者的临床诊断。 方法 应用随机对照临床试验的方法对1993年 1月至 2 0 0 1年 6月经手术和病理学证实的 2 878例肝SOL进行临床流行病学分析。结果HCC组和非HCC组AFP的敏感性是 6 9 9% (16 5 0 /2 36 2 )和 8 9% (46 /5 16 ) ,特异性是 91 1% (470 /5 16 )和 30 1% (712 /2 36 2 ) ,阳性预测值是 97 3% (16 5 0 /16 96 )和 2 7% (46 /16 96 ) ,P值均小于 0 0 1。结论(1)在有肝SOL存在时 ,AFP低浓度升高也有重要诊断价值 ,并不需要等待AFP大于 2 0 0或 5 0 0 μg/L才能诊断HCC ;(2 )提出低甲胎蛋白浓度HCC的概念有利于在AFP较低浓度时作出HCC的早期诊断 ,可减少 18%AFP 2 1～ 2 0 0 μg/LHCC患者的漏诊 ;(3)用AFP大于 2 0 μg/L结合B型超声、CT等联合诊断 。
ObjectiveTo investigate the value of low positive AFP level for the diagnosis of hepatocellular carcinoma (HCC) when a space occuping lesion (SOL) was already identified in the liver.MethodsUsing randomized controlled clinical trial,a clinical epidemiological analysis was made based on the result of surgery and pathology proven hepatic SOL of 2?878 cases admitted from January 1993 to June 2001.In this series,there were 2?362 HCC cases, among which 424 HCC cases were with a low positive AFP level(between 21 and 200?μg/L) which constitutes the basis of our analysis.ResultsIn HCC and non HCC groups,the sensitivity,specificity and positive predictive value were 69 9%(1?650/2?362) vs.8 9%(46/516) ( P <0 01),91 1%(470/516) vs.30 1%(712/2?362) ( P <0 01) and 97 3%(1?650/1?696) vs 2 7%(46/1?696) ( P <0 01) respectively. Conclusions (1)The AFP level between 20 and 200?μg/L is of diagnostic for HCC when a SOL is identified.(2)The clinical reference diagnostic criteria using AFP level more than 20?μg/L,instead of more than 200?μg/L is helpful for the diagnosis and avoiding misdiagnosis of 18% HCC.(3)Combined diagnosis of AFP level more than 20?μg/L and ultrasonography or CT scanning yields higher sensitivity and specificity than traditional diagnostic criteria.
出处
《中华普通外科杂志》
CSCD
北大核心
2002年第9期549-550,共2页
Chinese Journal of General Surgery
关键词
肝细胞癌
诊断
甲胎蛋白类
Carcinoma,hepatocellular
Diagnosis
Alpha fetoproteins
