甲胎蛋白联合异常凝血酶原检测原发性肝癌的临床应用

Clinical application of alpha fetoprotein combined with abnormal prothrombin in detecting primary liver cancer

目的 探讨血清甲胎蛋白（AFP）联合异常凝血酶原（PIVKA-II）检测用于原发性肝癌的临床价值.方法 选取2017年5～10月德阳市人民医院肝胆外科80例原发性肝癌患者（原发性肝癌组）、100例非原发性肝癌患者（非原发性肝癌组）血清（包括慢性肝病、肝硬化、转移性肝癌患者）,另选取健康体检者100例作为对照组.分别检测血清标本AFP和PIVKA-Ⅱ水平.所有数据采用SPSS17.0分析软件进行统计分析.结果 原发性肝癌组与非原发性肝癌组AFP与PIVKA-Ⅱ比较,F＝1.763;F＝1.788,sig＝0.000,P＜0.05;非原发性肝癌组与正常组AFP与PIVKA-Ⅱ比较,F＝0.896;F＝0.346,sig＝0.000,P＜0.05.血清AFP单独诊断原发性肝癌敏感性为75.0%,特异性为71.5%,PIVKA-Ⅱ单独诊断原发性肝癌敏感性为82.0%,特异性为78.7%.采用AFP联合PIVKA-Ⅱ不同的联合诊断方案,可将诊断原发性肝癌的敏感度和特异性分别提高到92.0%和95.0%. PIVKA-Ⅱ联合AFP诊断原发性肝癌的敏感性与单独AFP及PIVKA-Ⅱ相比,差异均有统计学意义（χ2＝4.112,P＝0.008;χ2＝2.991,P＝0.010）.结论 血清AFP和PIVKA-Ⅱ联合检测原发性肝癌具有重要的临床意义.

Objective To investigate the clinical value of serum alpha fetoprotein （ AFP） combined with abnormal prothrombin（PIVKA-Ⅱ） in the detection of primary liver cancer.Methods From May 2017 to October 2017,80 cases of primary liver cancer in Department of Hepatobiliary Surgery of Deyang People ＇s Hospital,100 cases of non HCC patients （ including chronic liver disease ,cirrhosis,metastatic liver cancer ） were selected,and another 100 healthy people were selected as control group.The levels of serum AFP and PIVKA -Ⅱ were detected by SIEMENS XP automatic immunoassay analyzer and lumipulseg 1200 automatic immune analyzer respectively.All data were analyzed by SPSS17.0 analysis software.Results Comparison between primary liver cancer and non -primary liver cancer：the levels of serum AFP and PIVKA -Ⅱ（F＝1.763;F＝1.788,sig＝0.000,P＜0.05）.Comparison between non-primary liver cancer and normal group：the levels of serum AFP and PIVKA -Ⅱ（F＝0.896;F＝0.346,sig＝0.000,P＜0.05）.Serum AFP had a sensitivity of 75.0%and a specificity of 71.5%in the diagnosis of primary liver cancer, while PIVKA -Ⅱ had a sensitivity of 82.0% and a specificity of 78.7%.The diagnosis sensitivity and specificity of AFP combined with PIVKA -Ⅱreached to 92.0% and 95.0%.The sensitivity of AFP combined with PIVKA-Ⅱin the diagnosis of primary liver cancer had statistically significant differences compared with AFP and PIVKA-Ⅱalone（χ2＝4.112,P＝0.008;χ2＝2.991,P＝0.010）.Conclusion Combined detection of serum AFP and PIVKA-II has important clinical significance in the diagnosis of primary liver cancer .