血清胱抑素C、5’-核苷酸酶及甲胎蛋白联合检测在肝细胞癌诊断中的应用

Clinical application of combined detection of serum Cys-C, 5′-NT and AFP in hepatocellular carcinoma

目的 探讨血清胱抑素C（Cys-C）、5′-核苷酸酶（5′-NT）和甲胎蛋白（AFP）单独及联合检测在肝细胞癌（HCC）诊断中的应用,为早期诊断及预后评估提供依据.方法 分别采用胶乳增强免疫透射比浊法、过氧化物酶法和电化学发光免疫分析法测定148例HCC患者（HCC组）、135例肝硬化患者（肝硬化组）、155例肝炎患者（肝炎组）和100名健康体检者（对照组）的血清Cys-C、5′-NT和AFP含量,比较其差异,计算敏感度、特异度及约登指数,并应用受试者工作特征（ROC）曲线进行分析.结果 血清Cys-C、5’-NT和AFP的水平在HCC组、肝硬化组、肝炎组和对照组之间差异均具有统计学意义（F值分别为12.35、42.25、58.12,P值均为0.000）.三者联合检测HCC的敏感度为100％,较单项及两两联合检测的敏感度均高,差异有统计学意义（P＜0.05）,而特异度为78.97％;二者联合检测HCC的ROC曲线下面积为0.977,较单项及两两联合检测结果均高,差异亦具有统计学意义（P＜0.05）.结论 血清Cys-C、5’-NT和AFP联合检测可提高HCC诊断的敏感性和准确性,对HCC的早期诊断具有重要价值,值得在临床上推广应用.

Objective To explore the clinical application of single or combined detection of serum Cys-C,5′-NT and AFP in hepatocellular carcinoma （HCC） in order to provide the platform for early diagnosis and prognosis evaluation.Methods The serum levels of Cys-C,5′-NT and AFP from 148 cases of HCC patients （HCC group）,135 cases of liver cirrhosis patients （LC group） and 155 cases of hepatitis （hepatitis group） and 100 healthy people （control group） were measured by latex-enhanced immunoturbidimetric assay （LEITD）,peroxidase method and electrochemiluminescence immunoassay （ECLI）,respectively.Then their differences had been compared.The sensitivity,specificity and Youden′s index were calculated and the results were analyzed by receiver operating characteristic （ROC） curve.Results The levels of serum Cys-C,5′-NT and AFP were significantly different in 4 groups.The differences were statistically significant （F =12.35,42.25,58.12,P =0.000）.The sensitivity of three indicators for diagnosing HCC was 100 %,which was higher than that of single or two combined detection （P 〈 0.05）,and the specificity was 78.97 %.The area under ROC curves of combined detection of three indicators was 0.977,which was also higher than single or two combined detection （P 〈 0.05）.Conclusions The combined detection of serum Cys-C,5′-NT and AFP can greatly increase the sensitivity and accuracy for diagnosing HCC,which has an important clinical value for early diagnosis.Therefore it is worth popularizing and applying on clinic.