GP73和AFP-L3在甲胎蛋白低浓度肝癌诊断中的临床意义

Clinical significance of serum GP73,AFP-L3 test in the diagnosis of primary hepatic carcinoma with low concentration of alpha-fetoprotein

目的:考察血清高尔基体蛋白73(Glogi glycoprotein 73,GP73)和甲胎蛋白异质体3(alpha-fetoprotein-L3,AFP-L3)对诊断低浓度甲胎蛋白(alpha-fetoprotein,AFP,AFP<108.0μg/L)原发性肝癌(primary hepatic cancer,PHC)的价值。方法:收集低浓度AFP PHC患者50例,非肝癌的消化系统疾病患者60例(其中慢性肝炎、肝硬化、其他消化系统恶性肿瘤患者各20例)及健康对照者40例。用酶联免疫分析定量检测各组人群血清GP73含量,微量离心柱分离AFP-L3后用电化学发光法测定总AFP和AFP-L3含量,并计算AFP-L3占总AFP的百分含量;比较各指标不同组间中值。结果:肝癌组GP73含量(105.4μg/L)明显高于非肝癌的消化系统疾病组(39.7μg/L)和健康对照组(19.3μg/L),P均<0.01。AFP-L3(%)在肝癌组(15.6%)明显高于非肝癌的消化系统疾病组(9.5%)和健康对照组(9.4%),P均<0.01。肝癌组GP73和AFP-L3(%)阳性检出率均明显高于其他各组,P均<0.01。单项检测中GP73和AFP-L3(%)灵敏度为74.0%和62.0%;特异性为96.0%和93.0%;准确率为88.7和82.7%;ROC曲线下面积分别为0.828和0.778。联合检测中GP73或AFP-L3(%)任一阳性诊断灵敏度最高(80.0%),GP73和AFP-L3(%)同时阳性诊断特异性最高(100.0%)。结论:血清GP73和AFP-L3单独诊断低浓度AFP的PHC灵敏度和特异性都较高,可用于AFP低浓度肝癌的辅助诊断;二者联用可增加PHC诊断的准确性。

Objective：To investigate the value of serum Glogi glycoprotein 73 （GP73） and alpha-fetoprotein-L3 （AFP-L3） in the di- agnosis of primary hepatic cancer（PHC） exhibiting low levels of alpha-fetoprotein（AFP）（AFP〈108.0 μg/L）. Methods：Totally 50 cases of PHC with low levels of AFP,60 cases of non-PHC digestive system disorders（20 cases of hepatitis,20 cases of liver cirrhosis and 20 cases of malignant tumors of digestive system） and 40 cases of healthy controls were collected. Serum GP73 was analyzed by enzyme-linked immunosorbent assay. AFP-L3 was separated by microspincolumn. Levels of AFP-L3 and AFP were quantified by electrochemiluminescence immunoassays. Percentage of AFP-L3 in total AFP was calculated. Different indicators among groups were compared. Results：Level of serum GP73 was higher in PHC patients （105.4μg/L） than in non-PHC patients with digestive system disorders（39.7 μg/L） and healthy controls（ 19.3 μg/L）（all P〈0.01 ）. Level of AFP-L3（%） was higher in PHC patients（ 15.6% ） than in non-PHC patients with digestive system disorders（9.5%） and healthy controls（9.4%）（P〈0.01）. Positive detection rates of GP73 and AFP-L3 （%） in PHC group was higher than those in other groups（P〈0.01 ）. Sensitivity, specificity and accuracy rates in the diag- nosis of PHC by GP73 alone were 74.0%, 96.0% and 88.7% respectively,while those via AFP-L3 （%） alone were 62.0%, 93.0% and 82.7% correspondingly. Areas under ROC analysis curve were 0.828 and 0.778. In the combined detection,the highest sensitivity of GP73 or AFP-L3 （%） positive diagnosis was 80.0% and the highest sensitivity of GP73 and AFP-L3 （%） positive diagnosis was （100.0%）. Conclusions：Both GP73 and AFP-L3 are effective tumor biomarkers to aid the diagnosis of PHC with low levels of AFP and their combination significantly improves the diagnosis of PHC.