GP73和AFP单项与联合诊断原发性肝癌的价值

Diagnostic value of Golgi-73 and AFP alone or combination in primary hepatocelluar carcinoma

目的探讨血清高尔基体糖蛋白73（GP73）和甲胎蛋白（AFP）单项与联合诊断原发性肝癌（PHC）的应用价值。方法选择2011年5月至9月在新疆医科大学第一附属医院80例PHC、65例肝硬化、54例慢性肝炎患者、50名健康人，用ELISA定量检测血清GP73含量，用电化学发光法平行测定AFP，并评价GP73单项和联合AFP诊断PHC的敏感度和特异度。结果PHC组血清GP73为282．0（163．6—366．7）μg/L，肝硬化组为211．8（107．5—295．7）μg/L，慢性肝炎组为100．3（61．8—191．3）μg/L，健康对照组为58．3（43．4～83．6）μg/L，经Kruskal-Wallis检验，4组间差异有统计学意义（H=106．6，P〈0．01）；经Mann-Whitney检验，PHC组分别与肝硬化、肝炎及健康对照组比较，GP73水平差异均有统计学意义（U值分别为1796．0、826．5、154．0，P均〈0．01）。GP73诊断PHC的敏感度[82．5％（66／80）]高于AFP[66．3％（53／80），矿=4．65，P〈0．05]；GP73的特异度[63．3％（107／169）]低于AFP[88．7％（150／169）并。=28．91，P〈0．05]。80例肝癌组中，AFP阴性者27例，其中GP73检出阳性22例，GP73检测AFP阴性肝癌患者阳性率为[81．5％（22／27）]；PHC组中GP73阴性者14例，其中AFP检出阳性9例，AFP检测GP73阴性肝癌患者阳性率为[64．3％（9／t4）]。2项指标串联检测诊断PHC的特异度[95．9％（162／169）]高于单项AFP[88．7％（150／169），，=6．00，P〈0．05]；2项指标并联检测诊断PHC的敏感度[93．8％（75／80）]高于单项GP73[82．5％（66／80），n=4．84，P〈0．05]。PHC患者合并HBV感染52例、HCV感染10例和无病毒感染者18例，GP73浓度分别为309．5（170．5—370．5）、351．0（274．7—397．9）、210．1（156．8～306．7）μg/L，经Kruskal—Wallis检验，三组差异无统计学意义（H=4．0，P〉0．05）。结论GP73和AFP单项诊断PHC的敏感度和特异度具有较好的互补性，并联检测能有效避免一些AFP阴性漏检病佻。

Objective To explore the application value of Golgi protein-73 （ GP73 ） and AFP in single and combining form in the diagnosis of primary hepatocelluar carcinoma （ PHC ）. Methods Eighty PHC, 65 liver cirrhosis, 54 chronic hepatitis patients and 50 controls were selected in the First Affiliated Hospital in Xinjiang Medical University from May to September in 2011, GP73 was detected by ELISA and AFP was measured by clinical chemiluminescence. The sensitivity and specificity of each parameter in single and combining form were evaluated. Results Serum GP73 in PHC group 282. O（ 163.6-366.7 ） μg/L, liver cirrhosis group 211.8（107.5-295.7） p,g/L, chronic hepatitis group 100. 3（61.8-191.3）μg/L and control group 58.3（43.4-83.6） μg/L was tested by Kruskal-Wallis（H = 106. 6, P 〈0. 01 ）. GP73 in PHC group was further compared with liver cirrhosis group, chronic hepatitis group and control group using Mann- Whitney test, significance was found, （ U was 1796. 0, 826. 5, 154. 0, respectively, all P 〈0. 01 ）. In the single form, the sensitivity of GP73 [ 82.5% （ 66/80 ） ] was higher than AFP [ 66. 3% （ 53/80 ）, X2 = 4. 65,P 〈0. 051, but the specificity of GP73 [63.3% （107/169） ] was lower than AFP [88.7% （ 150/ 169） ,X2 =28.91 ,P 〈0. 05]. There were 27 AFP negative cases in PHC group, but 22 of them were GP73 positive, making the positive rate of GP73 [ 81.5% （22/27）% in PHC patients with AFP negative. There were 14 GP73 negative cases of in PHC group, but 9 of them were AFP positive, making the positive rate of AFP [64.3% （9/14）I in PHC patients with GP73 negative. In series diagnostic test, the specificity of combining form [ 95.9 % （ 162/169 ） ] was higher than AFP [ 88.7 % （ 150/169 ）, X2 = 6.00, P 〈 0.05 ] ; in parallel diagnostic test, the sensitivity of combining form [ 93.8% （75/80） ] was higher than GP73 [ 82. 5% （66/80）, X2 = 4. 84,P 〈0. 051. In PHC group, 52 patients with HBV infection, 10 patients with HCV infection and 18 patients without virus infection, GP73 was 309. 5 （ 170. 5-370. 5）μg/L, 351.0 （274. 7- 397.9）μg/L and 210. 1 （ 156. 8-306. 7 ） μg/L, respectively, no significance was found （ H = 4. 0, P 〉 0.05）. Conclusion GP73 and AFP have a complementary feature of sensitivity and specificity in the early diagnosis of PHC, some PHC cases with AFP negative can be avoided missing efficiently by parallel diagnostic test.