血清壳多糖酶3样蛋白1和甲胎蛋白及铁蛋白检测在原发性肝癌诊断中的应用评价

Evaluation on application of serum chitinase-3-like protein 1,alpha-fetoprotein and ferritin detection to diagnosing hepatocellular carcinoma

目的探讨血清壳多糖酶3样蛋白1(CHI3L1)、甲胎蛋白(AFP)和铁蛋白(FER)单一及联合检测在原发性肝癌诊断中的临床应用价值。方法选取HCC患者61例,肝硬化患者31例,慢性肝炎患者31例以及健康体检者32例作为研究对象,采用定量酶联免疫吸附法检测血清中CHI3L1的水平,化学发光法检测血清AFP及FER水平。采用非参数秩和检验进行差异分析,通过ROC曲线下面积分析,比较单项及联合检测的诊断价值。结果 HCC组、肝硬化组、肝炎组及健康组的血清CHI3L1水平分别为258.60(215.61~296.75)、227.40(127.10~285.20)、145.40(79.60~198.70)、39.40(31.67~45.80)ng/ml;AFP水平分别为9.99(4.20~81.13)、4.34(1.16~26.22)、1.00(0.86~1.87)、1.12(1.00~1.96)ng/ml;FER水平分别为176.27(125.56~201.53)、151.74(81.46~202.59)、119.55(45.70~147.75)、106.67(79.47~147.15)ng/ml,四组三项指标差异均有统计学意义(H=92.39、52.08、33.25,P<0.001)。CHI3L1、AFP及FER三项指标单项检测时AUC分别(0.822±0.033)、(0.796±0.037)、(0.749±0.039)。三指标联合检测时AUC为(0.877±0.027),高于三指标单项检测。结论 CHI3L1在肝癌诊断方面具有一定的潜在价值,CHI3L1、AFP及FER联合诊断能提高诊断效能。

Objective To explore the clinical application values of detecting serum chitinase-3-like protein 1（CHI3L1）, alpha-fetoprotein（AFP） and ferritin（FER）alone or in combination for the diagnosis of hepatocellular carcinoma （HCC）. Methods Sixty-one patients with HCC, 31 patients with liver cirrhosis, 31 patients with chronic hepatitis and 32 physical examinees were selected as the research subjects. Quantitative enzyme-linked immunosorbent assay was used to detect the serum level of CHI3L1. Serum levels of AFP and FER were measured by chemiluminescence assay. CHI3L1, AFP and FER levels of the four groups were analyzed using the nonparametrictests. Receiver operating characteristic （ROC） curve and the area under ROC curve （AUC） were employed to assess the diagnostic values of the above-mentioned indexes applied alone or in combination. Results Serum levels of CHI3L1 in HCC, liver cirrhosis, chronic hepatitis and control groups were 258.60 （215.61-296.75） ng/ml, 227.40 （127.10-285.20）ng/ml, 145.40 （79.60-198.70） ng/ml and 39.40（31.67-45.80）ng/ml respectively. The serum levels of AFP in the four groups were 9.99（4.20-81.13） ng/ml, 4.34（1.16-26.22） ng/ml, 1.00（0.86-1.87） ng/ml and 1.12（1.00-1.96）ng/ml respectively. The serum levels of FER in the four groups were176.27（125.56-201.53） ng/ml, 151.74（81.46-202.59） ng/ml, 119.55（45.70-147.75） ng/ml and 106.67（79.47-147.15） ng/ml respectively. The serum levels of CHI3L1, AFP and FER of the four groups showed statistically significant differences （H=92.39, H=52.08, H=33.25, all P〈0.001）.The AUC of CHI3L1, AFP and FER alone was （0.822±0.033）, （0.796±0.037） and （0.749±0.039） respectively. The AUC of combination of CHI3L1, AFP and FER was（0.877±0.027）, which was higher than the AUC of CHI3L1, AFP and FER alone. Conclusions CHI3L1 is a potential marker for HCC diagnosis. The combination of CHI3L1, AFP and FERdetection can improve the diagnosis of HCC.