去γ-羧基凝血酶原、甲胎蛋白在原发性肝细胞癌中的诊断价值

The diagnostic value of des-gamma-carboxyprothrombin and alpha-fetoprotein in primary hepatocellular carcinoma

目的:探讨肿瘤标志物去γ-羧基凝血酶原(des-γ-carboxy prothrombin,DCP)、甲胎蛋白(alpha-fetoprotein,AFP)联合检测对原发性肝细胞癌(hepatocellular carcinoma,HCC)的诊断价值。方法:172例研究对象分为正常对照组25例、慢性肝炎组20例、肝硬化组51例及HCC组76例,酶联免疫法(ELISA)测定血清DCP浓度,电化学发光免疫法(ECLIA)测定血清AFP浓度,应用Logistic回归、ROC曲线对DCP、AFP、两者联合检测结果进行分析评价。结果:(1)正常对照组、慢性肝炎组、肝硬化组及HCC组DCP平均浓度分别为(17.72±9.59)、(26.12±12.64)、(37.45±18.26)和(806.71±639.79)mAU/mL,DCP浓度在4组间呈递增趋势(P<0.05),且HCC组DCP浓度显著高于其他3组(P<0.01)。正常对照组、慢性肝炎组、肝硬化组及HCC组AFP平均浓度分别为(7.93±5.42)、(14.59±11.91)、(16.29±14.10)和(547.47±544.98)ng/mL,HCC组AFP浓度明显高于其他3组(P<0.01)。(2)DCP、AFP单独诊断HCC的ROC曲线下面积(AUROC)分别为0.891、0.813,DCP综合诊断效能优于AFP(P<0.05);通过Logistic回归模型形成的联合预测因子(combining predictors,Comb)为分析指标,DCP、AFP联合检测时AUROC为0.932,优于DCP或AFP单独检测(P<0.05)。(3)通过ROC曲线确定DCP、AFP及Comb诊断HCC的最佳界定值分别为73.35mAU/mL、35.38ng/mL、0.28,此时具有较高的灵敏度和特异度。结论:DCP对我国HCC患者具有较好的诊断价值,运用Logistic回归、ROC曲线及诊断界定值综合分析DCP、AFP对HCC进行诊断,大大提高了诊断效能。

Objective This study aimed to investigate the diagnostic values of the combined detection of the serum levels of des-gamma-carboxyprothrombin （DCP） and alpha-fetoprotein （AFP） in patients＇ with hepatocellular carcinoma. Methods Serum levels of DCP and AFP were measured in 76 patients with HCC, 51 patients with liver cirrhosis, 20 chronic hepatitis patients and 25 healthy subjects using enzyme-linked immunosorbent assay （ELISA） and electrochemiluminescence immunoassay （ECLI）. The logistic regression analysis and receiver operating characteristic （ROC） curve analysis were performed to evaluate the diagnostic value of the DCP, AFP and the combined test results. Results （ 1 ） The mean serum concentrations of DCP in normal healthy subjects, patients with chronic hepatitis, cirrhosis and HCC were respectively （17.72± 9.59）, （26.12 ±12.64）, （37.45 ± 18.26） and （806.71± 639.79） mAU/mL, while the mean serum concentrations of AFP were respectively （7.93± 5.42）, （14.59 ± 11.91）, （16.29 ± 14.10） and （547.47 ± 544.98） ng/mL. Both DCP and AFP levels in HCC were significantly higher than those in other three groups. DCP levels progressively increased from normal healthy subjects to HCC. （2） The area under the ROC curves （AUROC） revealed that DCP had a better accuracy than AFP in diagnosis of HCC（0.891 vs 0.813, P 〈 0.05）. The analysis of indicators by logistic regression model indicated that the AUROC result of joint predictor （DCP, AFP joint detection） was 0.932, superior to the DCP or AFP alone （P 〈 0.05）. （3） The OOPs of the diagnostic kit of DCP, AFP and Comb were determined at 73.35 mAU/mL, 35.38 ng/mL, 0.28 with higher sensitivity and specificify. Conclusion DCP had a better diagnostic value than AFP in differentiating HCC from nonmalignant chronic liver disease in China. It was accurate to diagnose HCC with logistic regression and the cut-off value calculated by ROC curve method.