Fibroscan与AFP-L3％在HBV/HCV相关性肝癌诊断中的价值

目的探讨肝脏瞬时弹性成像（Fibroscan）与甲胎蛋白异质体比值（AFP—L3％）在HBV／HCV相关性肝癌中的临床诊断意义。方法检测慢性HBV／HCV感染后病毒性肝炎、肝硬化、肝癌患者的Fibroscan和AFP-L3％，根据肝硬度值（LSM）不同，分析其在HBV与HCV相关性肝癌、肝炎肝硬化患者中临床意义和二者的相关性。结果肝癌组与肝炎肝硬化组比较，当LSM≥12KPa，≥24KPa，≥36KPa时，二者差异均有统计学意义（P〈0．0001）。HBV与HCV相关性肝癌患者比较，当LSM≥12KPa，单项阳性率与双项阳性率差异无统计学意义（P〉0．05）；当3LSM≥24KPa，单项阳性率HBv相关性肝癌组46．88％，HCV相关性肝癌组75．00％，差异有统计学意义（P〈0．05）；双项阳性率HBV相关性肝癌组34．38％，HCV相关性肝癌组45．00％，差异无统计学意义（P〉0．05）；当LSM≥36KPa，单项阳性率HBV相关性肝癌组34．38％，HCV相关性肝癌组65．00％（P〈0．05）；双项阳性率HBV相关性肝癌组15．63％，HCV相关性肝癌缉45．00％，差异有统计学意义（P〈0．05）。HCV相关性肝癌患者Fibroscan与AFP-L3％进行相关性分析，两者呈正相关（r=0．421，P〈0．05）。结论在HBV与HCV相关性肝癌中，Fibroscan与AFP-L3％联合检测阳性率高于肝炎肝硬化组；LSM≥24KPa时，单项阳性HCV相关性肝癌高于HBV相关性肝癌；HCV相关性肝癌中LSM与AFP-L3％呈正相关。

Objective The clinical significance of transient liver imaging （ Fibroscan ） and Alpha-fetoprotein heteroplasm ratio （ AFP-L3% ） in the diagnosis of hepatocellular carcinoma （ HCC ） with HBV/HCV. Methods To test the Fibroscan and AFP-L3% in patients with viral hepatitis/ liver cirrhosis or hepatocellular carcinoma related chronic HBV / HCV infection, then analyze their clinical significance and correlation in HCC, hepatitis/liver cirrhosis patients according the LSM. Results Comparing the HCC group and hepatitis/liver cirrhosis group, there was significant difference between the two groups （P〈0.0001） when LSM≥ 12KPa, ≥24KPa, ≥36KPa. In the HBV/HCV related hepatocellular carcinoma group, while no significant difference between the positive rate of single item and double item were found when LSM〉12KPa （P〉0.05 ） .When LSM i〉 24KPa, the positive rate of single item was 46.88% in HBV-related HCC group and 75.00% in HCV-related HCC group （ P〈0.05 ） .The positive rate of double items was 34.38% in HBV-related HCC group and 45.00% in HCV-related HCC group （ P〉0.05 ） .When LSM≥36KPa, the positive rate of single item was 34.38% in HBV-related HCC group and 65.00% in HCV-related HCC group （/〉〉0.05） ; double positive rate was 15.63% in HBV- related HCC group and 45.00% in HCV-related HCC group （ P〈0.05 ） .There was a positive correlation between Fibroscan and AFP-L3% in HCV- related HCC patients （ r=0.421, P〈0.05 ） . Conclusion Comparing HBV/HCV-related HCC and hepatitis/cirrhosis patients, the positive rate of Fibroscan and AFP-L3% test was higher than that in the before.When LSM≥24KPa, the single positive rate in HCV-related HCC group is higher than HBV-related HCC group.There is a positive correlation between LSM and AFP-L3% in HCV-associated HCC.