血清PIVKA-Ⅱ在原发性肝癌诊断中的应用

Clinical application of serum PIVKA-Ⅱ in diagnosis of primary liver cancer

目的探究血清PIVKA-Ⅱ对原发性肝癌的诊断价值。方法 2016年2月至11月就诊于徐州医科大学附属医院肝癌患者330例,采用LUMI-PULSE G1200全自动免疫分析仪检测患者血清PIVKA-Ⅱ和AFP水平,比较二者在原发性肝癌的诊断和预后监测中的作用。结果血清PIVKA-Ⅱ检测原发性肝癌的敏感度(83.19%)高于血清AFP(66.37%,校正χ2=7.60,P=0.006),且两者联合检测的敏感度(89.38%)也高于血清AFP(校正χ2=16.05,P=0.00);血清PIVKA-Ⅱ与肿瘤体积呈正相关(r=0.63,P=0.00),且随着肿瘤直径增大而检测敏感度提高;血清PIVKA-Ⅱ在肝癌Ⅲ期和Ⅳ期分别高于Ⅰ期和Ⅱ期(Ⅲ期:U=151.00、173.00,P=0.00、0.04;Ⅳ期:U=238.50、292.50,P=0.00、0.02);原发性肝癌患者经手术或介入治疗后,血清PIVKA-Ⅱ下降幅度(80.13%)高于血清AFP(57.87%,χ2=4.226,P=0.04)。结论血清PIVKA-Ⅱ检测原发性肝癌的敏感度和特异度均高于AFP,并且在原发性肝癌的预后亦具有较大意义,可作为临床上检测和评价原发性肝癌预后的肿瘤标志物。

Objective To investigate the clinical value of serum prothrombin induced by vitamin K absence-Ⅱ（PIVKA-Ⅱ）in diagnosis of primary liver cancer.Methods Peripheral venous blood serum was collected from330 patients from February 2016 to November 2016 in our hospital.Serum PIVKA-Ⅱ and alpha-fetoproteins（AFP）levels were measured using LUMI-PULSE G1200 automated immunoassay analyzer,and further analyzed for evaluating their clinical value in diagnosing and monitoring primary liver cancer.Results Serum levels of both PIVKA-Ⅱ and AFP in primary liver cancer group were higher than those in chronic hepatitis group and liver cirrhosis group（PIVKA-Ⅱ：U =1016,280.5,582.5,P=0.00,0.00,0.00;AFP：U=3534,1225,2849,P=0.00,0.00,0.00）.The sensitivity of serum PIVKA-Ⅱ（83.19%）and combination of PIVKA-Ⅱ and AFP（89.38%）was higher than serum AFP（66.37%,adjustedχ2=7.60,P=0.006,χ2=16.05,P=0.00）in diagnosing primary liver cancer,respectively.The serum level of PIVKA-Ⅱ was positively correlated with tumor volume（r=0.63,P=0.00）,and the sensitivity of detection was positively correlated with tumor size.The serum level of PIVKA-Ⅱ was higher in stageⅢ and IV than that in stage I andⅡ,respectively（Ⅲ：U=151.00,173.00,P= 0.00,0.04;IV：U=238.50,292.50,P=0.00,0.02）.The serum levels of PIVKA-Ⅱ and AFP had no significant correlation with tumor differentiation.The serum levels of PIVKA-Ⅱ and AFP were significantly increased in early primary liver cancer with portal vein thrombosis,intrahepatic metastasis and lymph node enlargement（U=134.00,183.00,P=0.00,0.01）.The levels of serum PIVKA-Ⅱ and AFP were significantly decreased in patients with primary liver cancer after operation or intervention therapy（Z=-5.08,-4.28,P=0.00,0.00）,and the level of serum PIVKA-Ⅱ（80.13%）decreased more than the level of AFP（57.87%,χ2=4.226,P=0.04）.Conclusion PIVKA-Ⅱ detection had a higher sensitivity and specificity for diagnosing primary liver cancer than AFP,which could be used as a tumor marker for clinical detection and prediction of primary liver cancer prognosis.