肿瘤标志物DCP和AFP在原发性肝癌中的诊断价值

Utility of DCP and AFP in diagnosis of primary liver cancer

目的探讨血清肿瘤标志物异常凝血酶原（DCP）和甲胎蛋白（AFP）单独或联合检测在原发性肝癌（PLC）诊断中的临床意义。方法采用酶联免疫吸附测定法（ELISA）分别对70例PLC患者、每组各50例的肝硬化患者、乙型肝炎患者、健康体检者的血清DCP和AFP进行检测，并比较各组水平差异，并采用Spearing．相关分析探讨AFP和DCP之间的关系，用ROC曲线评价AFP和DCP诊断PLC的敏感度、特异度，从而明确DCP和AFP在PLC中的诊断价值。结果PLC组患者血清中的DCP和AFP水平均显著高于肝硬化、肝炎和正常组，差异具有统计学意义（P〈0．01）。单独检测诊断PLC时，通过ROC曲线分析DCP的曲线下面积大于AFP（P〈0．01），分别为0．977（95％CI：O．954～1．000）和0．853（95％CI：0．785～0．921），Spearman相关分析表明AFP和DCP之间无显著相关性。单独检测时DCP诊断PLC的敏感度（90．0％）和特异度（97．3％）显著高于AFP（77．1％，76．7％），AFP和DCP联合检测时可提高诊断PLC的敏感度（95．7％）。结论DCP是诊断PLC良好的血清肿瘤标志物，诊断PLC时的敏感度和特异度高于AFP；联合检测DCP和AFP可提高PLC诊断的敏感度，避免临床漏诊PLC的发生。

Objective To explore the clinical diagnosis significance of single or combined testing the levels of serum des- gamma-carboxy prothrombin（DCP） and alpha-fetoprotein （AFP） in primary liver cancer（PLC）. Methods The serum levels of DCP and AFP in 70 patients with PLC,in 50 patients with cirrhosis of liver, and in 50 patients with viral hepatitis type B and in 50 healthy cases were detected by the enzyme-link immunosorbent assay（ELISA）. The difference was com- pared with each other. The Spearman correlation analysis was performed to explore the relation between DCP and AFP. The sensitivity and specificity of the DCP and AFP for the diagnosis of PLC were analyzed by ROC Curve. The clinical di- agnosis value of DCP and AFP in PLC was evaluated. Results The serum DCP and AFP level in the PLC group was sig- nificantly higher than that in the cirrhosis of liver group, in the viral hepatitis type B group and in the healthy cases group, the differences was statically significant（P 〈 0.01 ）. The Area Under Curve of the ROC Curve of the DCP single detection for PLC was greater than that AFP（P 〈0.01 ）. The area under Curve of the ROC Curve of the DCP and AFP were 0. 977 （95% CI：0. 954 - 1. 000） and 0. 853 （95% CI：0. 785 - 0. 921 ） ,respectively. There were not significantly correlation be- tween AFP and DCP level by Spearman correlation analysis. The sensitivity（90.0% ） and specificity（97.3% ） of DCP single detection were significantly higher than AFP for the diagnosis of PLC. The sensitivity （95.7%） increased in the clinical diagnosis of the PLC by using AFP and DCP combined detection. Conclusion DCP is a very effective serum tumor maker in the clinical diagnosis of the PLC. DCP and AFP combined detection can increase the sensitivity in the PLC clinical diagnosis and refrain from the missed diagnosis of the PLC.