甲胎蛋白异质体3、异常凝血酶原、甲胎蛋白检测肝细胞癌的对照研究

Clinical evaluation of three tumor markers in hepatocellular carcinoma diagnosis:alpha-fetoprotein-L3,des-gamma-carboxy prothrombin and alpha-fetoprotein

目的分析3种肿瘤标志物甲胎蛋白异质体(AFP-L3)、异常凝血酶原(DCP)、甲胎蛋白(AFP)单独或联合检测肝细胞癌(HCC)的临床意义。方法分别用电化学发光法检测AFP,ELISA法检测AFP-L3、DCP,利用受试者工作特征曲线(ROC曲线)分析3种标志物单独和联合检测肝细胞癌(随机组和AFP阴性组)的敏感性、特异性、曲线下面积、阳性预测值和阴性预测值。比较肝细胞癌组与健康对照组和疾病对照组的AFP-L3、DCP、AFP水平的差异。分析治疗前AFP阴性肝细胞癌病例联合检测AFP-L3、DCP的意义。结果①单独检测肝细胞癌病例的3种肿瘤标志物,AFP-L3的敏感性、特异性分别是48.7%、97.7%;DCP的敏感性、特异性分别是42.5%、98.4%;AFP的敏感性、特异性分别是68.7%、94.6%。联合检测AFP-L3、DCP和AFP,敏感性、特异性分别是87.5%、92.2%。②肝细胞癌随机组的AFP-L3、DCP、AFP水平与健康对照组和疾病组比较差异有高度统计学意义(P<0.01)。③AFP阴性肝细胞癌组的AFP和AFP-L3水平与肝良性疾病组比较差异无统计学意义,但DCP水平差异有统计学意义(P<0.05)。结论 AFP-L3、DCP与AFP单独检测时AFP的敏感性最高,而DCP的特异性最高,是区分肝硬化与AFP阴性的肝细胞癌血清学的良好指标。AFP-L3、DCP与AFP的联合检测能提高肝细胞癌血清学检测的敏感性和特异性,在肝细胞癌诊断方面比目前大多数传统的组合方法更优胜、更准确。

Objective To determine values of detecting alpha-fetoprotein-L3（AFP-L3）,des-gamma-carboxypro-hrombin（DCP） and alpha-fetoprotein（AFP） alone or in combination for diagnosis of hepatocellular carcinoma （HCC）.Methods Serum samples from 259 patients, including 130 HCC cases without treatment and 129 cases as controls, were detected for AFP by ECLIA, DCP and AFP-L3 by ELISA respectively.They were also analyzed by Receiver operating characteristic （ROC）.Results The sensitivity of AFP-L3, DCP, and AFP was 48.7%, 42.5%, 68.7%, respectively.And the specificity was 97.7%,98.4%,92.2%, respectively.Value of the three markers between the HCC group and the control group showed significantly different when compared separately （P0.05）.While those in combination, the sensitivity, specificity were 87.5%, 92.2%.There were 79 HCC pa-tients whose AFP were negative the DCP value of them showed significant differences（P0.05）, while AFP-L3 showed no differences.Conclusions Among the three markers,AFP is the most sensitive, and DCP is the high-est specific.DCP may be the better marker for those AFP-negative patients of HCC.The combination of AFP-L3, DCP and AFP can elevate the sensitivity and have a highly specificity,which is superior for diagnosis of HCC compared with each marker alone or to other combinations.