血清可溶性Endogin对肝硬化和肝细胞癌的诊断和鉴别诊断价值研究

Serum soluble endogin levels in the diagnosis of patients with liver cirrhosis and hepatocellular carcinoma

目的探讨肝硬化和肝细胞癌（HCC）患者血清可溶性Endogin（sEng）水平差异及其对鉴别诊断的临床意义。方法2009年6月至2014年6月在我院就诊的乙型肝炎肝硬化患者77例、HCC患者54例和健康人36例，采用化学发光法检测血清甲胎蛋白（AFP）水平；采用ELISA法检测血清sEng；sEng与临床指标的相关性检验采用Pearson或Spearman相关分析；采用受试者工作特征曲线下面积（AUC）评价sEng及其联合AFP检测诊断HCC的价值；观察不同sEng水平的HCC患者3a生存率的差异。结果HCC患者血清sEng水平为19．71（15．16～23．56）ng／L，显著高于肝硬化患者[6．42（4．23～9．89）ng／Ll和健康人[2．83（2．28～3．30）ng／L，P〈0.05]；HCC患者sEng与AFP水平呈正相关（r=0.660，P〈0．001）；sEng或sEng联合AFP鉴别HCC与健康人的AUC分别为0．912（95％CI：0．851—0．973）和0．951（95％CI：0．911—0．992）；sEng或sEng联合AFP鉴别HCC与肝硬化的AUC分别为0．849（95％CI：0．778—0．920）和0．920（95％CI：0．867～0．972）；高血清sEng水平（≥20．0ng／L）的HCC患者3a生存率（24．0％）显著低于低血清sEng水平（〈20．0ng／L）者（41．4％，P〈0.05.结论肝硬化与HCC患者血清sEng水平存在差异，可作为HCC患者诊断的参考指标。

Objective To investigate serum levels of soluble endogin （sEng） and its clinical significance in the patients with liver cirrhosis and hepatocellular carcinoma（ HCC ）. Methods From June 2009 to June 2014, 77 patients with HBV related liver cirrhosis,54 patients with HCC and 36 healthy individuals who had been treated in our hospital were enrolled in this study. The serum levels of alpha fetoprotein （AFP） were assayed by chemiluminescent immunoassay and the serum levels of sEng were detected by enzyme-linked immunosorbent assay. The correlations of sEng and clinical indexes were analyzed by Pearson or Spearman correlation analysis. Furthermore,the diagnostic values of sEng and AFP for HCC were analyzed with ROC curve,and the patients with HCC with different levels of sEng were followed up for three years. Results Serum level of sEng in patients with HCC [19.71 （15.16-23.56） ng/L] were significantly higher than that in patients with liver cirrhosis 16.42 ng/L （4.23-9.89）ng/L] or in healthy controls [-2.83（2.28-3.30） ng/L,P〈0.05];there was a significant positive correlation between serum sEng and serum AFP in patients with HCC （r=0.660,P〈0.001）;the area under curve （AUC） in discriminating HCC from health control by sEng or sEng with AFP were 0.912 （95%CI： 0.851-0.973） and 0.951 （95%CI：0.911-0.992）;the AUC in discriminating HCC from cirrhosis by sEng or sEng with AFP were 0.849 （95% CI：0.778-0.920） and 0.920 （95%CI：0.867-0.972）;3 a overall survival rates were 24.0% in HCC patients with serum sEng ≥20.0 ng/L and 41.4% in HCC patients with serum sEng〈20.0 ng/L,respectively （P〈0.05）. Conclusion The detection of serum sEng can not only improve the diagnosis of HCC,but also has a certain value in prognosis of patients with HCC in clinical practice.