甲胎蛋白、甲胎蛋白异质体及其比值检测在肝细胞癌诊断中的应用价值研究

Clinical value of serum AFP,AFP-L3 and AFP-L3/AFP ratio in primary hepatocellular carcinoma

目的讨论甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)以及AFP-L3/AFP检测结果在肝细胞癌(HCC)与慢性乙型肝炎(CHB)的鉴别诊断中的临床应用价值。方法回顾性分析65例HCC患者和120例CHB患者血清中AFP、AFP-L3含量及AFP-L3/AFP值;采用耦联小扁豆凝集素(LCA)的微量离心柱分离血清中AFP-L3,然后采用雅培化学发光法进行AFP、AFP-L3检测同时计算AFP-L3/AFP的值。结果 HCC患者血清AFP-L3/AFP平均值0.23远远高于CHB组的0.08,差异有统计学意义(F=52.172,P<0.01);HCC受试者工作特征曲线(ROC曲线)面积显示AFP-L3/AFP面积最大,为0.905;当AFP-L3/AFP≥0.15时诊断HCC的敏感度和特异性分别为90.2%、85.4%。结论对HCC的诊断血清AFP-L3/AFP结果优于AFP和AFP-L3单测结果,AFP-L3/AFP对HCC和CHB的鉴别诊断具有重要临床意义。

Objective To explore the clinical value of alpha-fetoproteins（ AFP）,alpha-fetoprotein variant（ AFP-L3） and AFP-L3/AFP in primary hepatocellular carcinoma（ HCC） and chronic hepatitis B（ CHB）. Methods The serum levels of AFP,AFP-L3 and AFP-L3/AFP in 65 patients with HCC and 120 patients with CHB were retrospectively analyzed. AFP-L3 was separated from the serum by a micro-centrifugal column coupled with lentil lectin（ LCA）. AFP and AFP-L3 were detected by Abbott Chemiluminescence and the values of AFP-L3/AFP were calculated. Results The mean value of serum AFP-L3/AFP in patients with HCC was 0. 23,which was much higher than 0. 08 in CHB group,and the differences were statistically significant（ F = 52. 172,P〈0. 01）. The area of HCC receiver operating characteristic curve（ ROC curve） showed AFP-L3/AFP was the largest（ 0. 905）; when AFP-L3/AFP was ≥0. 15,the sensitivity and specificity in the diagnosis of HCC were 90. 2% and 85. 4%,respectively. Conclusion AFP-L3/AFP is more sensitive than the amounts of AFP and AFP-L3 in the diagnosis of HCC,and shows certain value in the differential diagnosis of HCC and CHB diseases.