AFP、CA19-9、SF、AFU联合肝脏MRI诊断原发性肝癌的效能分析

Analysis of Diagnostic Efficiency of AFP,CA19-9,SF and AFU Detection Combined with MRI Scan for Liver Diagnosis of Primary Hepatocellular Carcinoma

目的分析血清甲胎蛋白(AFP)、糖蛋白抗原19-9(CA19-9)、铁蛋白(SF)、α-L-岩藻糖苷酶(AFU)检测联合肝脏MRI扫描对于原发性肝癌的诊断效能。方法选取2015年1月至2016年12月间本院收治的57例原发性肝癌患者作为恶性组,选取同期本院收治的57例肝脏良性病变患者作为良性组,选取同期在本院进行健康体检的57例健康受检者作为对照组,对比三组AFP、CA19-9、SF、AFU表达水平,将恶性组患者依据肝功能是否异常划分为正常亚组与异常亚组,对比AFP、CA19-9、SF、AFU(后简称四项标志物)的表达水平,以分析四项标志物的原发性肝癌中的表达特征;全部受检者行肝脏MRI检查,根据检测结果计算每项标志物及MRI对于原发性肝癌的诊断效能指标:符合率、灵敏度、特异性、漏诊率与误诊率,以串联原则计算四项标志物与MRI检查的联合诊断结果并计算诊断效能指标,同时分析各单项与联合诊断与确诊结果间的一致性;以ROC曲线分析血清四项标志物、MRI及联合诊断的诊断价值。结果三组间四项血清标志物比较差异均具有统计学意义,P<0.05;恶性组中肝功能正常亚组与肝功能异常亚组间四项血清指标比较差异均具有统计学意义,P<0.05。AFP、AFU、CA19-9、SF单项诊断结果与金标准间均具有一致性,P<0.05;MRI诊断结果与金标准间具有较高一致性,P<0.05;上述各项联合诊断与金标准间具有高度一致性,P<0.05。各项指标联合诊断PHC具有高度诊断价值,P<0.05;各单项指标诊断PHC具有中等诊断价值,P<0.05。结论血清AFP、CA19-9、SF、AFU及肝脏MRI对于原发性肝癌均具有一定的诊断效能,但联合诊断可提高诊断准确率,诊断价值最高,可为临床诊断提供更加精准的参考。

Objective To analyze diagnostic efficiency of the serum alpha fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), ferritin (SF）, and α-L-fucosidae （AFU） detection combined with MRI scan for liver diagnosis of primary hepatocellular carcinoma. Methods 57 patients with primary hepatocellular carcinoma who were treated in our hospital from January 2015 to December 2016 were selected as the malignant group. Besides,57 cases of patients with benign liver disease were selected as the benign group and 57 healthy subjects were selected as control group in the same period. The expression levels of AFP, CA19-9, SF and AFU were compared between the three groups. According to whether liver function was abnormal malignant, patients were divided into normal subgroup and abnormal subgroup. The expression levels of AFP, CA19-9, SF,AFU(hereafter referred to as ＂four markers＂）were compared to analyze the expression characteristics of four markers in primary liver cancer. All the subjects underwent liver MRI examination. The diagnostic efficacy of each marker and MRI for primary hepatocellular carcinoma was calculated according to the test results ： coincidence rate, sensitivity, specificity, missed diagnosisrate and misdiagnosis rate. Results There were significant differences in the four serum markers between the three groups (P 〈 0.05). There were significant differences in the four serum markers in the normal subgroup and the abnormal subgroup of liver function in the malignant group （P 〈 0.05). AFP, AFU, CA19-9, SF single diagnosis results were consistent with the gold standard （P 〈 0.05). MRI diagnosis results were also highly consistent with the gold standard （P 〈 0.05). The above-mentioned combined diagnosis were a high degree of consistency with the gold standard (P 〈 0.05). The combined various indexes in diagnosis of PHC had high diagnostic value （P 〈 0.05). Each individual index had a moderate diagnostic value of PHC diagnosis(P 〈0.05). Conclusion Serum AFP,CA19-9, SF, AFU and liver MRI have certain diagnostic efficacy for primary hepatocellular carcinoma, the combined diagnosis can improve the diagnostic accuracy, and the diagnosis value is the highest, which can provide a more accurate reference for clinical diagnosis.