摘要
目的探讨血清甲胎蛋白(AFP)、血清异常凝血酶原(PIVKA-Ⅱ)、α-L-岩藻糖苷酶(AFU)的检测在乙肝病毒相关肝细胞肝癌(HCC)诊断中的临床应用价值。方法收集638例慢性乙肝患者,其中包含2016年3月-2017年12月间在本院就诊的124例乙肝相关肝癌患者和同时间段来源于广州达安临床检验中心的325例单纯慢性乙肝患者以及189例乙肝肝硬化患者标本。对所有患者AFP、PIVKA-Ⅱ、AFU水平进一步分析。用ROC曲线评估3种标志物单独检测和联合检测用于从慢性乙肝患者中筛选乙肝相关肝癌的效果。结果与肝硬化乙肝组和慢性乙肝组相比,乙肝肝癌组患者血清中AFP和PIVKA-Ⅱ的水平明显升高,差异有统计学意义(P<0.05)。乙肝肝癌组的AFU水平明显高于慢性乙肝组,差异有统计学意义(P<0.05)。3种标志物单独检测时PIVKA-Ⅱ的AUC最大,其次为AFP,AFU的AUC最小(P<0.05)。当AFP、AFU、PIVKA-Ⅱ3者联合检测时AUC最大,且诊断肝癌的敏感性和特异性分别达到88.4%和93.3%,高于3种标志物单独或者两者联合检测的敏感性和特异性。3种标志物联合检测从肝硬化患者中筛查肝癌时的AUC更大。结论 PIVKA-Ⅱ、AFU、AFP联合检测能够提升乙肝相关肝癌的早期诊断效率,尤其当慢性乙肝患者发生肝硬化时,联合检测筛选出肝细胞癌的能力更加突出。
Objective To investigate the diagnostic value of serum alpha-fetoprotein(AFP),prothrombin induced byvitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)andα-L-fucosidase(AFU)in the diagnosis of hepatocellular carcinomainduced by hepatitis B virus.Methods A total of 638 patients with chronic hepatitis B(CHB)were included.Including124 cases of hepatitis B virus-associated hepatocellular carcinoma(HCC)who were admitted to Affiliated Cancer Hospital&institute of Guangzhou Medical University from March 2016 to December 2017.At the same time,325 patients withcirrhosis-free hepatitis B and 189 HBV patients with cirrhosis from Da an Clinical Testing Center,Guangzhou were alsocollected as control.All patients were analyzed for AFP,PIVKA-Ⅱ,and AFU levels in their serum.The ROC curve wasused to evaluate the effects of three markers alone and in combination for the screening of hepatitis B-related liver cancerfrom patients with chronic hepatitis B.Results Compared with chronic hepatitis B liver cirrhosis group and chronichepatitis B group,the levels of serum AFP and PIVKA-Ⅱin patients with hepatitis B liver cancer were significantly higher(P<0.05).The level of AFU in hepatitis B liver cancer group was significantly higher than that in chronic hepatitis B group(P<0.05).The AUC of PIVKA-Ⅱwas the largest when the three markers were detected separately,followed by AFP,andthe AUC of AFU was the smallest.When AFP,AFU,and PIVKA-Ⅱwere combined,the AUC was the largest,and thesensitivity and specificity of diagnosis of liver cancer were 88.4%and 93.3%,respectively.Both were higher than the threemarkers alone or in combination.Conclusion The combined detection of PIVKA-Ⅱ,AFU and AFP could improve theearly diagnosis efficiency of hepatitis B-related liver cancer.Especially when cirrhosis occurs in patients with chronichepatitis B,the ability of combined detection and screening of hepatocytes was more prominent.
作者
席红利
黄文瑾
唐明珠
尚彦彦
XI Hong-li;HUANG Wen-jin;TANG Ming-zhu;SHANG Yan-yan(Affiliated Cancer Hospital&Institute of Guangzhou Medical University,Guangzhou,Guangdong 510095;Daan Clinical Testing Center,Guangzhou,Guangdong 510507,China)
出处
《热带医学杂志》
CAS
2019年第8期1016-1019,1027,共5页
Journal of Tropical Medicine
基金
广州市卫生健康委员会西医类一般引导项目(20181A010063)
