PIVKA-Ⅱ、AFP、AFP-L3联合检测在肝细胞肝癌诊断中的价值

The value of serum PIVKA-Ⅱ,AFP and AFP-L3 in the diagnosis of hepatocellular carcinoma

目的探讨血清异常凝血酶原(PIVKA-Ⅱ)、血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)检测在肝细胞肝癌(HCC)诊断中的临床应用价值。方法选择2016年6-11月在山东大学附属省立医院中心院区住院的92例HCC患者为HCC组,64例肝硬化患者为肝硬化组,72例乙型肝炎患者为肝炎组,另选取70例健康人作为健康对照组,检测所有研究对象PIVKA-Ⅱ、AFP、AFP-L3水平并比较分析。结果 HCC组血清PIVKA-Ⅱ、AFP、AFP-L3水平明显高于肝硬化组、肝炎组和健康对照组,差异有统计学意义(P<0.05)。HCC组PIVKA-Ⅱ、AFP、AFP-L3的受试者工作特征曲线下面积分别为0.904、0.867、0.840。单项检测中,PIVKA-Ⅱ的灵敏度和准确度最高,为82.61%和87.92%;AFP-L3特异度最高,为93.20%。联合检测中,PIVKA-Ⅱ+AFP-L3以及PIVKA-Ⅱ+AFP+AFP-L3组合的特异度最高,为98.54%;PIVKA-Ⅱ/AFP/AFP-L3组合的灵敏度最高,为94.57%。结论 PIVKA-Ⅱ、AFP、AFP-L3联合检测可以提高HCC的诊断效能,弥补单项检测的不足。

Objective To explore the cllinical application values of protein induced by vitamin K absence or antagonist-]] （PIVKA-11 ）,Alpaha fetoprotein （AFP）,Alpha fetoprotein variants （AFP-L3） detection in the diagnosis of hepatocelluar carcinoma （HCC）. Methods From June of 2016 to November of 2016,92 cases of HCC patients who presented at Shangdong Province Hospital as HCC group;64 cases of cirrhotic patients as liver cirrhosis group;72 cases of chronic hepatitis patients as chronic hepatitis group and 70 healthy people as healthy control group. PIVKA-U , AFP and AFP-L3 were measured by commercial assay kits. Results The serum levels of PIVKA-Ⅱ ,AFP and AFP-L3 in HCC group were significantly higher than those in liver cir- rhosis group, chronic hepatitis group and healthy control group, and the differences were statistically signifi- cant （P^0. 05）. The area under the ROC curve of PIVKA-Ⅱ, AFP and AFP-L3 were 0. 904,0. 867 and 0. 840,respectively. Sensitivity and accuracy of PIVKA-Ⅱ in individual inspection were the highest, 82.61 and 87.9Z%, respectively. Specificity of AFP-L3 was the highest, 93. 20%. The specificity of PIVKA- Ⅱ ＋ AFP-L3 and PIVKA-Ⅱ＋ AFP＋ AFP-L3 combination were the highest, 98.54% the sensitivity of PIVKA- Ⅱ/AFP/AFP-L3 combination was the highest, 94. 570,/oo. Conclusion The allied combination of serum PIV- KA-Ⅱ ,AFP and AFP-L3 makes up for the insufficient clinical applications of individual serum markers. It is of great clinical significance to improve the diagnosis of HCC.