AFP-L3和PIVKA-Ⅱ检测对高危人群良恶性肝病的鉴别诊断价值

Performance of Serum AFP-L3 and PIVKA-Ⅱ in Differential Diagnosis of Benign and Malignant Liver Disease in High Risk Population

目的探讨AFP-L3和PIVKA-Ⅱ在联合检测对高危人群中良恶性肝病鉴别诊断的临床价值。方法回顾性分析48例原发性肝癌、43例肝硬化和81例慢性乙型肝炎患者血清甲胎蛋白异质体(AFP-L3)和异常凝血酶原(PIVKA-Ⅱ)水平。结果原发性肝癌组、肝硬化组和慢性乙型肝炎组三组间血清AFP水平差异无统计学意义(X^2=4.014,P=0.134);原发性肝癌组AFP-L3和PIVKA-Ⅱ的中位值均高于肝硬化组和慢性乙型肝炎组(X^2=33.93,52.33,均P<0.001);AFP-L3诊断肝癌的特异度较高(92.74%),PIVKA-Ⅱ的敏感度较高(79.17%),二者以串联方式联合检测将准确度提高到84.88%。结论 AFP-L3和PIVKA-Ⅱ以串联方式联合检测有助于高危人群良恶性肝病的鉴别诊断。

Objective To explore the performance of serum AFP-L3 and PIVKA- Ⅱ in differential diagnosis of benign and malignant liver disease in high risk population. Methods The serum levels of AFP-L3 and PIVKA- Ⅱ in 48 patients with prima- ry hepatic carcinoma,43 patients with cirrhosis and 81 patients with chronic hepatitis B were analyzed retrospectively. Results There was no statistically different significance among the median levels of serum AFP in primary hepatic carcinoma pa- tients, cirrhosis patients and chronic hepatitis B patients （x^2= 4.014, P = 0. 134）. Both median level of AFP-L3 and PIVKA- Ⅱ in primary hepatic carcinoma patients were higher than cirrhosis patients and chronic hepatitis B patients （x^2 = 33.93, 52.33,both of P values were below 0. 001）. The specificity （92. 74%） of AFP-L3 and the sensitivity （79.17%） of PIVKA-Ⅱ were all higher. The accuracy （84.88%） of combined detection in series was the highest, with its 47.92 % of sensitivity and 99.19% of specificity. Conclusion Combined detection PIVKA-Ⅱ and AFP-L3 series will help to differential diagnosis of benign and malignant liver disease in high risk population.