血清AFP、AFP-L3联合检测在原发性肝癌中的诊断价值

Diagnosis value of AFP and AFP-L3 combined detection in hepatocellular carcinoma

目的探讨甲胎蛋白（AFP）、甲胎蛋白异质体（AFPL3）以及AFP-L3比率在原发性肝癌（HCC）中的诊断价值。方法选取患者共354例,原发性肝癌（HCC）110例,良性肝病（BLD）244例（其中肝炎94例,肝硬化126例,肝良性肿瘤24例）,采用亲和吸附离心管分离AFP-L3,用电化学发光法测定AFP和AFP-L3含量,计算AFP-L3比率。结果110例HCC患者中,有32例AFP〈20 ng/ml,30例AFP 20-200 ng/ml,48例AFP〉200 ng/ml;244例BLD患者中,196例AFP〈20 ng/ml。HCC组AFP、AFP-L3和AFP-L3比率明显高于BLD组（P〈0.01）。AFP、AFP-L3和AFP-L3比率ROC曲线下面积（AUC）分别是0.809、0.819、0.800,而联合3种指标检测的AUC是0.829（P〈0.01）。AFP-L3比率的Cut-off值在5%、10%和15%时,诊断的灵敏度分别是59.1%、50.9%和40.9%,特异度分别是86.1%、94.7%和98.4%。结论 AFP和AFP-L3联合检测对HCC的诊断效能大于单独检测AFP。AFP-L3比率的最佳Cut-off值是5%。

Objective To explore the diagnostic value of alpha fetoprotein（ AFP）,alpha fetoprotein L3（ AFP-L3）and ratio of AFP-L3 to AFP in hepatocellular carcinoma（ HCC）. Methods In 354 patients,110 patients with hepatocellular carcinoma（ HCC） and 244 patients with benign liver disease（ BLD）（ including 94 patients with hepatitis,126 patients with liver cirrhosis and 24 patients with benign liver tumors）. AFP and AFP-L3 which was separated by affinity adsorption centrifugal tube were measured by electrochemiluminescence immunoassays,following calculation ratio of AFP-L3 to AFP. Results In 110 patients with HCC,the patients of AFP〈20 ng/ml,AFP 20-200 ng/ml and AFP〉200 ng/ml were 32 cases,30 cases and 48 cases respectively. In 244 patients with BLD,the patients of AFP〈20 ng/ml were 196 cases. Levels of AFP,AFP-L3 and ratio of AFP-L3 to AFP in patients with HCC were significantly higher than that in patients with BLD（ P〈0.01）. According to ROC curve,areas under the curve（ AUC） of AFP,AFP-L3 and ratio of AFP-L3 to AFP were 0.809,0.819 and 0.800 respectively,and AUC of combination three markers was 0.829（P〈0.01）. When the cut-off values of ratio of AFP-L3 to AFP were5%,10% or 15%,the sensitivities were 59. 1%,50. 9% or 40. 9%,and the specificities were 86.1%,94.7%or 98.4%. Conclusion Diagnostic value of combination AFP and AFP-L3 is higher than AFP in diagnosis of hepatocellular carcinoma. The best cut-off value of ratio of AFP-L3 to AFP is 5%.