血清AFP、TK1、DKK1联合检测对原发性肝癌的诊断价值

Combined detection of AFP,TK1 and DKK1 in diagnosis of primary hepatocellular carcinoma

目的探讨甲胎蛋白(AFP)、胸苷激酶1(TK1)、分泌型蛋白Dickkopf-1(DKK1)对原发性肝癌(PHC)的诊断价值。方法收集112例PHC患者、85例良性肝脏疾病患者和63例体检健康者,用电化学发光法检测血清AFP水平;免疫印迹增强化学发光法检测血清TK1水平;ELISA法检测各组血清DKKI水平;用Logistic回归模型绘制ROC曲线并计算曲线下面积(AUCROC)以评价各指标的诊断价值。结果 PHC患者血清AFP、TK1、DKK1水平明显高于良性肝病组及健康对照组,差异有统计学意义(F为11.36,8.72,6.66,P均<0.05);良性肝病组血清AFP水平明显高于健康对照组(q=16.62,P<0.05);AFP、TK1、DKK1三项指标用回归方程P=1/[1+e-(-5.175+0.328x1+0.133x2+0.006x3+0.112x4)]综合分析诊断PHC,其敏感性(90.2%)和准确性(91.9%)最高;预测概率pre-1(AUCROC=0.935,P=0.000)高于各项指标单独检测。结论血清AFP、TK1、DKK1检测对PHC的诊断具有重要价值,3项标志物联合检测可提高PHC诊断的敏感性和准确性。

Objective To investigate the diagnostic value of alpha-fetoprotein（ AFP）,thymidine kinase 1（ TK1） and Dickkopf-1（DKK1） in the diagnosis of primary hepatic carcinoma（PHC）. Methods In total,112 patients with primary hepatic carcinoma,85patients with benign hepatic diseases and 63 healthy controls were selected. The level of AFP in serum was determined by electrochemiluminescence. The level of TK1 was determined by Western blot-enhanced chemiluminecence,and the level of DKK1 was determined by ELISA. The diagnostic value was analyzed by logistic regression equation and ROC curve. Results The levels of AFP,TK1 and DKK1 of serum in PHC group were significantly higher than those in benign hepatic disease and control group（ F = 11. 36,8. 72,6. 66,all P〈0. 05）. AFP level in benign hepatic disease group was significantly higher than that in control group（q = 16. 62,P〈0. 05）. According to logistic regression equation： P = 1 /[1 ＋ e^-（- 5. 175 ＋ 0. 328x1 ＋ 0. 133x2 ＋ 0. 006x3 ＋ 0. 112x4）],the sensitivity（90.2%） and accuracy（91. 9%） of combined detection were significantly higher than those of single detection of AFP,TK1or DKK1. The predicted probability pre-1 of combined detection was higher than that of any single detection and the biggest area under the ROC curve was achieved（AUC^ROC= 0. 935,P = 0. 000）. Conclusion The determination of serum AFP,TK1 and DKK1 showed important value in diagnosis of PHC and combined detection could significantly improve the sensitivity and accuracy for diagnosis of PHC.