血清AFP、AFP-L3与GP73检测在原发性肝癌诊断中的应用价值

The application value of the detection of the serum AFP,AFPL3 and GP73 in the diagnosis of primary liver cancer

目的探讨血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)及高尔基体糖蛋白73(GP73)检测诊断原发性肝癌(PHC)的价值。方法采用电化学发光法分别检测100例PHC患者(肝癌组)、55例肝硬化患者(肝硬化组)和95例健康体检者(健康对照组)AFP,阳性者(≥20μg/L)采用微量离心柱法检测AFP-L3,并采用酶联免疫法检测GP73。结果 AFP、AFP-L3和GP73在肝癌组的检测值均高于肝硬化组、健康对照组(P<0.05);AFP单项诊断PHC的曲线下面积(AUG)为0.902,灵敏度67.0%,特异性90.7%,准确度81.2%;AFP-L3单项诊断的AUG为0.970,灵敏度37.0%,特异性100.0%,准确度74.8%;GP73单项诊断AUG为0.923,灵敏度56.0%,特异性98.0%,准确度81.2%;三者联合检测对PHC诊断的灵敏度提高为78.0%,特异性为90.0%,准确度为85.2%;单项与联合检测比较,差异有统计学意义(P均<0.05)。结论单项检测诊断PHC AFP-L3(%)优于GP73和AFP,三项联合检测可显著提高PHC的诊断敏感度和正确性。

Objective To investigate the application value of using serum AFP,AFP-L3 and GP73 to diagnose primary hepatocellular carcinoma（ PHC）. Methods Serum PHC was detected by using electrochemiluminescence assay in 100 patients with primary hepatocellular carcinoma（ Liver cancer group）,55 patients with liver cirrhosis diseases（ Cirrhosis group）and 95 healthy volunteers（ Healthy control group）. AFP-L3 was detected by using microspincolumn in patients with positive AFP（ ≥20 μg/L）. GP73 was quantitatively analyzed by using ELISA. Results The serum levels of AFP,AFP-L3 and GP73 in patients with PHC were significantly higher than that in patients with cirrhosis group and healthy controls group（ P〈0. 05）.In AFP single diagnosis,the value of area under curve（ AUC）,the sensitivity,specificity and accuracy for PHC were 0. 902,67. 0%,90. 7% and 81. 2% respectively. In AFP-L3 single diagnosis,the value of area under curve（ AUC）,the sensitivity,specificity and accuracy for PHC were 0. 907,37. 0%,100. 0% and 74. 8% respectively. In GP73 single diagnosis,the diagnostic value of area under curve（ AUC）,sensitivity,specificity and the accuracy for PHC were 0. 923,56. 0%,98. 0% and 81. 2% respectively. When combined the above three single diagnosis in the diagnosis of PHC,the sensitivity,specificity and accuracy were improved to 78. 0%,90. 0% and 85. 2% respectively and the difference was statistically significant（ P〈0. 05）. Conclusion The single diagnosis method of AFP-L3 is superior to GP73 and AFP in the early diagnosis of primary hepatocellular carcinoma. The combining the three single AFP,AFP-L3 and GP73 diagnosis can improve the sensitivity and accuracy in the diagnosis of primary hepatocellular carcinoma.