联合检测血清甲胎蛋白异质体浓度与甲胎蛋白异质体百分含量在原发性肝癌诊断中的价值

The Value of Combined Serum Alpha-fetoprotein Heteroplasmon-L3 Concentration and AFP-L3/Alpha-fetoprotein Ratio Detection in the Early Diagnosis of Primary Liver Cancer

目的通过检测肝病患者血清甲胎蛋白异质体(AFP-L3)浓度和AFP-L3/血清甲胎蛋白(AFP)比值,分析探讨并联运用两指标在肝细胞癌(HCC)诊断中的价值。方法选取2011年3月-11月137例的住院患者血清标本,AFP检测均为阳性。依据病理学诊断,将137例患者分为两组,HCC组92例,良性肝病组45例,后者包括肝硬化结节37例、慢性活动性肝炎8例。采用酶联免疫吸附试验(ELISA)检测所有患者血清AFP-L3浓度;同时运用微量吸附柱法分离血清中的AFP-L3,采用电化学发光法检测分离后的AFP-L3和血清中总AFP浓度,计算AFP-L3/AFP比值。计算采用AFP-L3浓度与AFP-L3/AFP比值以及AFP-L3浓度与AFP-L3/AFP比值两指标并联诊断HCC的灵敏度、特异度、Youden指数等统计学指标,探讨其在原发性肝癌诊断中的价值。结果①HCC组AFP-L3浓度(109.04±62.51)ng/mL,明显高于良性肝病组(25.96±49.43)ng/mL,差异有统计学意义(t=8.28,P<0.001)。HCC组血清AFP-L3/AFP比值(17.35±14.48%)高于良性肝病组(5.617±6.38%),差异有统计学意义(t=6.545,P<0.0001)。②以血清AFP-L3浓度>38.0 ng/mL作为临界值诊断原发性肝癌的灵敏度为83.69%,特异度为88.88%,以AFP-L3/AFP比值>10%作为临界值诊断原发性肝癌的灵敏度为83.69%,特异度为95.55%。③并联应用血清AFP-L3浓度>38.0 ng/mL、AFP-L3/AFP>比值7.5%诊断HCC的灵敏度为97.83%,特异度为84.44%。结论并联应运AFP-L3浓度与AFP-L3/AFP比值诊断HCC较应用单一指标诊断特异度稍有下降,但明显提高了诊断的灵敏度,更有利于HCC的早期诊断。

Objective To explore the value of combined serum alpha-fetoprotein inform （AFP-L3） and AFP-L3/AFP as biomarkers in the early diagnosis ofhepatocellular carcinoma （HCC）. Methods A total of 137 patients from the People＇s Hospital of Tangshan of Hebei Union University were included in our study. They were treated in hospital from March to November 2011. All the patients were at the age of 28 to 77 years old, and 98 of them were men, and 39 were women. According to the pathological diagnosis, patients were divided into two groups. HCC group had 92 patients, and benign liver disease group had 45 patients including 37 with liver cirrhosis and 8 with chronic hepatitis. ELISA method was used to test the serum AFP-L3 level. At the same time, microcentrifugal column method was adopted to separate AFP-L3 from the patients＇ serum, and electrochemical luminescence method was used to detect the separated AFP-L3 and total AFP levels. Then, we calculated the ratio of AFP-L3/AFP. We also calculated the statistical indexes of AFP-L3 level and AFP-L3/AFP ratio in the diagnosis of HCC, such as sensitivity, specificity and Youden index. The above indexes of combined AFP-L3 level and AFP-L3/AFP ratio were also detected to evaluated its diagnostic value. Results HCC group AFP-L3 level （109.04 ± 62.51） ng/mL was significantly higher than that of the benign liver disease group [（25.96 ±49.43） ng/mL; t=-8.28, P 〈 0.001]. HCC group serum AFP-L3/AFP ratio （17.35% ± 14.48%） was significantly higher than that of the benignliver disease group （5.62% ~ 6.38%, t=- 6.545, P 〈 0.000 1）. With serum AFP-L3 level 〉 38.0 ng/mL as a critical value of primary liver cancer diagnosis, the sensitivity was 83.69%, and the specificity was 88.88%. For AFP-L3/AFP ratio 〉 10% as a critical value in primary liver cancer diagnosis, the sensitivity was 83.69%, and the specificity was 95.55%. When serum AFP-L3 level 〉 38.0 ng/mL and AFP-L3/AFP ratio 〉 7.5% were combined in primary liver cancer diagnosis, the sensitivity was 97.83%, and the specificity was 84.44%. Conclusion Compared with application of single indicators, combined use of AFP-L3 level and the ratio of AFP-L3/AFP in the diagnosis of HCC significantly improves the diagnostic sensitivity, and is more conducive to the early diagnosis of HCC, although its diagnostic specificity is slightly lower.