脱-γ-羧基凝血酶原对原发性肝癌的诊断价值探讨

Investigation on the significance of des-gamma-carboxy-prothrombin in the diagnosis of primary hepatocellular carcinoma

目的探讨脱-γ-羧基凝血酶原(DCP)对原发性肝癌的诊断灵敏度、特异性的价值。方法采用化学发光法检测116例原发性肝癌患者、57例继发性肝癌患者、52例消化系统肿瘤患者、50例慢性肝病患者、73例其他肝脏疾病患者及50名健康体检者(正常对照组)血清DCP、甲胎蛋白浓度,并绘制DCP的受试者工作特征(ROC)曲线,计算诊断原发性肝癌的最佳诊断值。结果原发性肝癌组DCP浓度明显高于继发性肝癌组、消化系统肿瘤组、慢性肝病组、其他肝脏疾病组和正常对照组(P<0.05),而正常对照组、慢性肝病组、消化系统肿瘤组、其他肝脏疾病组之间差异无统计学意义(P>0.05)。由ROC曲线得出DCP诊断原发性肝癌的最适合临界值为44.5 mAU/mL,此时的灵敏度为74.2%、特异度为88.6%。DCP和AFP联合诊断原发性肝癌时的特异性可高达96%以上,灵敏度也可提高至91%以上。DCP和AFP的相关性分析显示二者无相关性(r=0.026,P=0.782)。结论 DCP对原发性肝癌具有较高的诊断价值,且能鉴别诊断原发性肝癌、继发性肝癌及其他良性肝脏疾病。DCP和AFP联合诊断可以提高对原发性肝癌的诊断效能。

Objective To investigate the diagnosis significance of des-gamma-carboxy-prothrombin （DCP） in patients with primary hepatocellular carcinoma, and to improve the sensitivity and specificity in the diagnosis of primary hepatocellular carcinoma. Methods A total of 116 patients with primary hepatocellular carcinoma and 57 patients with secondary liver cancer,52 patients with digestive system tumors,50 patients with chronic liver disease,73 patients with other liver diseases and 50 healthy subjects （healthy control group ） were enrolled. Their serum DCP and alpha fetoprotein（AFP） levels were determined by chemiluminescence. The receiver operating characteristic （ROC） curve was performed. The best diagnosis cut-off value of primary hepatocellular carcinoma was calculated. Results The DCP level in primary hepatocellular carcinoma group was significantly higher than those in the other groups （ P 〈 0.05 ） , and there was no statistical significance among the other 5 groups （ P 〉 0.05 ）. ROC curve showed that the most suitable diagnosis cut-off value of primary hepatocellular carcinoma was 44.5 mAU/mL. The sensitivity was 74.2% , and the specificity was 88.6%. The specificity of the combination determination of DCP and AFP was above 96% , and its sensitivity was above 91%. There was no correlation between DCP and AFP （r = 0. 026, P = 0. 782 ）. Conclusions DCP has diagnosis significance in the diagnosis of primary hepatocellular carcinoma, and in primary hepatoeellular carcinoma, secondary liver cancer and other benign liver diseases , it has identification significance. The combination determination of DCP and AFP can improve the diagnosis sensitivity and specificity of primary hepatocellular carcinoma.