壳多糖酶3样蛋白1与甲胎蛋白在肝细胞癌诊断中的比较

Comparative Diagnostic Value of Chitinase 3-Like 1 Protein and AFP in the Diagnosis of Hepatocellular Carcinoma

目的比较壳多糖酶3样蛋白1(chitinase 3-like 1,CHI3L1)和甲胎蛋白(alpha-fetoprotein,AFP)对肝细胞癌(HCC)的诊断的差异。方法选取南京医科大学第一附属医院2015年12月份~201 6年4月份收治入院且经病理学证实HCC患者100例,同时按性别和年龄配对选择慢性乙型肝炎患者100例和健康体检者59例作为对照组,分别检测HCC组、慢性乙型肝炎组和健康体检者的血清CHI3L1和AFP,使用STATA 12.0统计学软件,各组和两.组之间血清CHI3L1和AFP是否存在差异分别使用Kruskal-Wallis H检验和Mann-WhitneyU检验,同时使用MedCal Ver 15.2.2软件的诊断效能分析比较CHI3L1和AFP对HCC的诊断价值。结果多组之间血清CHI3L1水平存在显著差异(x^2=93.19,P=0.000),进一步进行两两比较,结果显示HCC组血清CHI3L1均显著高于慢性乙型肝炎组和健康体检组(P值均为0.000,z值分别为8.766和7.400);多组之间血清AFP水平存在显著差异(x^2=147.54,P=0.000),HCC组血清AFP均显著高于慢性乙型肝炎组和健康体检组(z=10.938,9.033;P值均为0.000);将HCC与慢性乙型肝炎组的CHI3L1和AFP做ROC曲线,CHI3L1的AUC为0.859(95%可信区间:0.803~0.904),临界值为76.8 pg/ml,敏感度和特异度分别为85%和79%;AFP的AUC为0.948(95%可信区间:0.904~0.974),临界值为7.6 ng/ml,敏感度和特异度分别为85%和98%,AFP的诊断效能优于CHI3L1(P=0.006);HCC与健康对照组之间ROC曲线结果比较,CHI3L1的AUC为0.852(95%可信区间:0.787~0.903),临界值为76.8 pg/ml,敏感度和特异度分别为85%和76%;AFP的AUC为0.929(95%可信区间:0.878~0.964),临界值为7.8 ng/ml,敏感度和特异度分别为84%和100%;AFP的诊断效能也优于CHI3L1,差异有统计学意义(P=0.045)。结论 CHI3L1和AFP对HCC均具有很高的诊断效能,但AFP的诊断效能优于CHI3L1。

Objective To investigate the different diagnostic value of serum Chitinase 3-like 1 protein（CHI3L1） and Alpha-fe- toprotein（AFP） in diagnosing hepatocellular carcinoma （HCC）. Methods One hundreds HCC patients confirmed by histopa- thology were recruited between December,2015 to April, 2016 from the First Affiliated Hospital of Nanjing Medical Univer- sity. Simultaneously, 100 patients with chronic hepatitis B and 59 healthy individuals,matched by sex and age with HCC pa- tients,were recruited as control groups. Serum CHI3L1and AFP were measured in different groups and the clifference were analyzed by STATA 12.0 Statistical software. The ability of these two items in differentiating different group was analyzing by ROC curve using MedCal Ver 15.2.2 software. Results Serum CHI3L1 were significantly differences in the three groups using Kruskal-Wallis analysis （χ2=93.19,P= 0. 000）,the differences were further compared in different two groups using Mann-Whitney analysis. The results showed that serum CHI3L1 in HCC group were significantly higher than in chronic hepatitis B and healthy control group （P=0. 000,z=8. 766,7. 400）. Serum AFP were significantly differences in the three groups using Kruskal-Wallis analysis （χ2=147.54,P=0. 000）, and the differences were further compared in different two groups using Mann-Whitney analysis. The results showed that serum AFP in HCC group were significantly higher than in chronic hepatitis B and healthy control group （P=0. 000, z=10. 938,9. 033）. The ROC curve analysis of serum CHI3L1 and AFP for differentiating HCC group from CHB group showed that CHI3L1 yield AUC of 0. 859 （95% CI：0. 803-0. 904） with 85% sensitivity, 79 % specificity and 76.8 pg/ml cut-off value,AFP yield AUC of 0. 948 （95% CI：0. 904-0. 974） with 85% sensitivity,98% specificity and 7.6 ng/ml cut-off value, in distinguishing HCC with CHB group, the power of AFPwas superior to that of CHI3L1 （P〈0. 006）. The ROC curve analysis of serum CHI3L1 and AFP for differentiating HCC group from healthy individuals group showed that CHI3L1 yield AUC of 0. 852 （95% CI：0. 787-0. 903） with 85% sensi- tivity,76% specificity and 76.8 pg/ml cut-off value,AFP yield AUC of 0. 929 （95% CI：0. 878-0. 964） with 84% sensitivi ty, 100 % specificity and 7.8 ng/ml cut-off value, in distinguishing HCC with healthy individuals group, the power of AFP was also superior to that of CHISIA （P=0. 045）. Conclusion Serum CHISL1 similar to AFP has much power ability to diagnosis HCC,but AFP was superior to CHI3L1.