甲胎蛋白半年变化对甲胎蛋白低度增高原发性肝癌的诊断价值

Diagnostic value of AFP semiannual variation in patients with primary liver cancer with low AFP

目的探讨AFP半年增长倍数对AFP低度增高原发性肝癌(PHC)的诊断价值。方法针对33例慢性乙型肝炎患者(CHB)、57例肝硬化患者(LC)及44例诊断时血清AFP浓度低于400 ng/ml的原发性肝癌患者,测定其诊断时的血清AFP含量,并回顾性收集其诊断前半年左右的AFP测定结果,计算AFP半年增长倍数。分析诊断时AFP浓度、约半年前AFP浓度、AFP半年增长倍数在不同组别间的差异,并比较用AFP浓度和AFP半年增长倍数对AFP低度增高的PHC诊断价值。结果 PHC组诊断时AFP浓度和AFP半年增长倍数均高于慢性乙型肝炎组和肝硬化组,差异有统计学意义(P<0.01)。通过受试者工作特征曲线(ROC)分析,采用AFP浓度和AFP半年增长倍数诊断PHC时ROC曲线下面积分别为0.803和0.934。结论定期检测慢性乙型肝炎患者和肝硬化患者的血清AFP浓度,并计算AFP半年增长倍数,对于PHC诊断价值优于采用一次测定的AFP结果,有助于PHC的早期发现。

Objective To investigate the diagnostic value of AFP half year growth multiples in primary hepatocellular carcinoma（ PHC）. Methods In 33 patients with chronic hepatitis B（ CHB）,57 cases of liver cirrhosis（ LC） and 44 cases of primary hepatocellular carcinoma with the AFP concentration lower than 400 ng/ml,serum AFP levels were measured at the time of diagnosis,the AFP determination results about half a year before were retrospectively collected,and the first half growth rate of AFP was calculated. The differences of AFP concentration,AFP concentration and AFP growth rate in different years among different groups were analyzed and compared,and the diagnostic value of AFP concentration and AFP semiannual growth multiple on AFP with low PHC was compared. Results The AFP concentration and AFP half-fold increase in PHC group were higher than those in chronic hepatitis B group and cirrhosis group,with the differences statistically significant（ P〈0. 01）. The receiver operating characteristic curve（ ROC） analysis showed that the area under the ROC curve was 0. 803 and 0. 934 for the diagnosis of PHC by AFP concentration and the AFP half-fold increase. Conclusion Regular detection of serum AFP concentration in patients with chronic hepatitis B and cirrhosis,and calculation of AFP growth rate of six months,for the diagnosis of PHC value,is better than the results of a single determination of AFP,which is helpful for the early detection of PHC.