维生素K缺乏或拮抗剂Ⅱ诱导的蛋白质在原发性肝细胞癌临床诊断中的应用

Application of serum protein induced by vitamin K absence or antagonist-Ⅱ in clinical diagnosis of hepatocellular carcinoma

目的研究血清维生素K缺乏或拮抗剂Ⅱ诱导的蛋白质（PIVKA-1／）检测在原发性肝细胞癌（HCC）临床诊断中的价值。方法收集北京大学第一医院门诊及住院患者共97例，其中HCC患者27例（均为肝硬化患者），非HCC患者70例（包括肝硬化患者47例，非肝硬化患者23例）。检测不同组间患者的AFP和PIVKA-Ⅱ，比较两者的灵敏度和特异性，绘制受试者工作特征曲线（ROC）分析曲线下面积，对所有人组患者做AFP和PIVKA-Ⅱ的相关性分析。结果HCC组血清AFP和P1VKA-Ⅱ水平均明显高于非HCC组（Z=-3．244、-3．329，P均〈0．01）。血清AFP单独诊断HCC的灵敏度和特异性分别为81．48％、42．86％，血清PIVKA-Ⅱ单独诊断HCC的灵敏度和特异性分别为74．04％、48．57％，两者差异无统计学意义（P均〉0．05）。采用AFP和PIVKA-Ⅱ不同的联合诊断方案，可将诊断HCC的灵敏度和特异性分别提高到100．00％和91-43％。ROC分析结果显示，AFP、PIVKA-Ⅱ和AFPxPIVKA-Ⅱ（AFP和PIVKA-Ⅱ之积）曲线下面积分别为0．713（95％CI：0．594-0．832）、0．719（95％CI=0．607-0．831）、0．751（95％CI：0．636-0．867）。所有患者的AFP和PIVKA—Ⅱ的Pearson相关系数为0．370（P〈0．01），HCC患者的Pearson相关系数为0．400（P〈0．05）。结论血清PIVKA-Ⅱ用于HCC的诊断价值与血清AFP相当，可作为临床诊断HCC的血清学标记物。血清PIVKA-Ⅱ与AFP联合检测可明显提高对HCC的诊断效能。

Objective To investigate the diagnostic value of serum protein induced by vitamin K absence or antagonist-Ⅱ （PIVKA-Ⅱ） in hepatocellular carcinoma（HCC） patients. Methods There were 97 patients enrolled from Peking University First Hospital, including 27 patients with HCC （all with cirrhosis） and 70 patients without HCC （47 patients with cirrhosis and 23 patients without cirrhosis, respectively）. Serum alpha fetoprotein （AFP） and PIVKA-Ⅱ were detected in each group, and their sensitivity and specificity were compared. Meanwhile, receiver operating characteristic （ROC） curve and the correlation analysis of AFP and PIVKA-Ⅱ were carried out. Results Serum AFP and PIVKA-Ⅱ were significantly higher in HCC group than those in non-HCC group（Z= -3.244, -3.329, P both 〈0.01）. The sensitivity and specificity of AFP in the diagnosis of HCC were 81.48% and 42.86% ,while the sensitivity and specificity of PIVKA-Ⅱ were 74.04% and 48.57%. The differences had no statistical significance （P both〉0.05）. By using different combined dignostic schemes of AFP and PIVKA-Ⅱ, the diagnostic sensitivity and specificity of HCC could achieve 100.00% and 91.43%, respectively. The areas under the ROC curve of AFP, PIVKA-Ⅱ and AFP×PIVKA-Ⅱ were 0.713 （95% CI： 0.594-0.832）, 0.719 （95% CI： 0.607-0.831） and 0.751 （95% CI： 0.636-0.867）, respectively. The Pearson correlated index of AFP and PIVKA-Ⅱ was 0.370（P〈0.01 ） in all patients, while it was 0.400 （P〈0.05） in HCC group. Conclusions The diagnositc value of PIVKA-Ⅱ is similar as AFP, and it can be regarded as a serologic marker for clinical diagnosis of HCC. Moreover, the combined dignostic scheme of AFP and PIVKA-Ⅱ can improve the diagnostic efficiency.