血清AFP、GPC3、VEGF、IGF-Ⅱ单独及联合检测对原发性肝细胞癌的诊断价值

Diagnostic value of serum AFP alone or in combination with glypican 3,VEGF or IGF-II for patients with primary hepatocellular carcinoma

目的:分析血清AFP、GPC3、VEG、IGF-Ⅱ单独及联合检测对原发性肝细胞癌(hepatocellular carcinoma,HCC)的诊断价值.方法:66例经病理确诊的HCC患者和16例肝炎肝硬化患者,采用微粒子酶联免疫法测定血清AFP,ELISA检测GPC3、VEGF及IGF-Ⅱ.AFP≥400μg/L作为诊断HCC临界值,根据ROC曲线确定GPC3、VEGF及IGF-Ⅱ的最佳临界值.结果:单独分析4个指标对HCC诊断价值:其敏感度依次为GPC3>IGF-Ⅱ>AFP>VEGF,特异度依次为AFP>GPC3>VEGF>IGF-Ⅱ.AFP联合其他指标,以AFP+GPC3诊断效能最高.其中,AFP<20μg/LHCC患者,GPC3的阳性率最高达51.1%,早期HCC(BCLC,StageA)患者,GPC3阳性率高达50.0%.结论:血清AFP≥400μg/L对HCC患者诊断有较大局限性,AFP联合GPC3明显提高HCC的诊断效能,值得扩大病例数进一步研究.

AIM：To evaluate the diagnostic value of serum alpha-fetoprotein（AFP） alone or in combination with glypican 3（GPC3）,vascular endothelial growth factor（VEGF） or insulin-like growth factor-II（IGF-II） for patients with primary hepatocellular carcinoma（HCC）.METHODS：Serum AFP,GPC3,VEGF and IGF-II were measured by enzyme-linked immunosorbent assay in 66 patients with histopathologically proven HCC and 16 cirrhotic patients.The cut-off level of AFP for diagnosis of HCC was 400 μg/L,while those of GPC3,VEGF and IGFII were determined using ROC curve analysis.RESULTS：The sensitivity of serum GPC3 for diagnosis of HCC was highest,followed by serum IGF-II,AFP and VEGF.The specificity of serum AFP for diagnosis of HCC was highest,followed by serum GPC3,VEGF and IGF-II.AFP in combination with GPC3 was most useful for diagnosis of HCC,especially early HCC.In AFPnegative HCC patients,the positive rate of GPC3 was 51.1%.In patients with early HCC（BCLC stage A）,the positive rate of GPC3 was 50.0%.CONCLUSION：Detection of serum AFP（≥400 μg/L） alone has its imitations in the diagnosis of HCC.AFP in combination with GPC3 is most useful for diagnosis of HCC,especially early HCC.