血清甲胎蛋白异质体、高尔基体蛋白73和谷氨酰转肽酶联合检测对肝细胞肝癌的诊断价值

Diagnostic value of serum AFP-L3, GP73 and GGT combined detection in hepatocellular carcinoma

目的 探讨联合检测血清甲胎蛋白异质体（AFP-L3）、高尔基体蛋白73（GP73）以及谷氨酰转肽酶（GGT）在肝细胞肝癌（HCC）诊断中的价值.方法 141例肝病患者依据病理诊断分为HCC组与良性肝病组,HCC组74例,良性肝病组67例.采用ELISA法检测-80 ℃保存的两组患者血清AFP-L3、GP73水平,回顾分析GGT检测结果,比较两组AFP-L3、GP73以及GGT差异,运用受试者工作特征曲线（ROC曲线）确定各指标诊断HCC的临界值,分析单独运用AFP-L3、GP73、GGT以及三种指标联合诊断HCC的价值.结果 HCC组AFP-L3水平为（113.58±63.62）μg/L,明显高于良性肝病组的（23.19±34.54）μg/L （P＜0.001）,ROC曲线下面积为0.802,以AFP-L3浓度38.47μg/L为临界值,AFP-L3诊断HCC的敏感度为81.08％,特异度为88.06 ％;HCC组GP73水平为（126.55±49.56） μg/L,明显高于良性肝病组的（56.97±26.48） μg/L（P＜ 0.001）,ROC曲线下面积为0.811,以GP73水平69.44 μg/L为临界值,GP73诊断HCC的敏感度为75.68％,特异度为91.04 ％;HCC组GGT水平为（173.20±179.18）U/L,明显高于良性肝病组的（90.77±81.53）U/L（P＜ 0.001）,ROC曲线下面积为0.713,以GGT水平110.77 U/L为临界值,GGT诊断HCC的敏感度为74.32％,特异度为77.61％.联合检测AFP-L3、GP73、GGT诊断HCC的敏感度为83.78％,特异度为92.53％.结论 肿瘤标志物AFP-L3、GP73及GGT的联合检测可提高HCC的确诊率,具有较高的临床应用价值.

Objective To explore the clinical value of AFP-L3,GP73 and GGT as biomarkers in diagnosis of hepatocellular carcinoma （HCC）.Methods According to the pathological diagnosis,141 patients were divided into two groups,HCC group were 74 cases,benign liver disease group were 67 cases.Use ELISA method tested the serum AFP-L3 and GP73 levels.The GGT level was detected by the automatic biochemical instrument of all the 141 patients.AFP-L3,GP73 and GGT concentration difference was compared between the two groups.ROC curve was used to determine the cut-off level to diagnose HCC.The value of single use AFP-L3,GP73,GGT and joint the three indexes to diagnose HCC were analyzed.Results The average level of AFP-L3 in the patients with HCC was （113.58±63.62） μg/L,it was significantly higher than that in the patients with benign liver diseases [（23.19±34.54） μg/L] （P ＜ 0.001）.The area under the ROC curve of AFP-L3 level was 0.802.Taking AFP-L3 level ≥ 38.47 μg/L as diagnostic criteria,the sensitivity of AFP-L3 level in HCC diagnosis was 81.08 ％ and the specificity was 88.06 ％.The average level of GP73 in the patients with HCC was （126.55±49.56） μg/L,it was significantly higher than that in the patients with benign liver diseases [（56.97±26.48） μg/L] （P ＜ 0.001）.The area under the ROC curve of GP73 level was 0.811.Taking GP73 level≥69.44 μg/L as diagnostic criteria,the sensitivity of GP73 level in HCC diagnosis was 75.68 ％ and the specificity was 91.04 ％.The average level of GGT in the patients with HCC was （173.20±179.18） U/L,it was significantly higher than that in the patients with benign liver diseases [（90.77±81.53） U/L] （P ＜ 0.001）.The area under the ROC curve of GGT level was 0.713.Taking GGT level ≥ 110.77 U/L as diagnostic criteria,the sensitivity of GGT level in HCC diagnosis was 74.32 ％ and the specificity was 77.61％.Joint use AFP-L3,GP73 and GGT to diagnose HCC,the sensitivity was 83.78 ％,specificity was 92.53 ％.Conclusion Combined detection of tumor markers AFP-L3,GP73 and GGT can improve the positive rate of HCC,which has good clinical application value.