GP73、AFP-L3、TIP30联合检测对乙型肝炎源性肝癌肝硬化的诊断价值

The value of combined tests of serum GP73,AFP-L3 and TIP30 in diagnosis of HBV related hepatocellular carcinoma and cirrhosis

目的探究血清高尔基体蛋白73(GP73)、甲胎蛋白异质体3(AFP-L3)、Tat结合蛋白30(TIP30)联合检测对乙型肝炎源性肝癌、肝硬化的诊断价值。方法收集乙型肝炎病毒携带患者血清标本150份,其中慢性乙型肝炎患者50例、肝硬化患者50例、原发性肝癌患者50例,及另外健康对照者血清标本40份。用酶联免疫分析定量检测各组人群血清GP73、TIP30水平,微量离心柱分离AFP-L3,电化学发光法测定血清总AFP和分离洗脱液中AFP-L3水平,并计算AFP-L3/AFP比例。结果随着慢性乙型肝炎、肝硬化、肝癌的进程,GP73、AFP-L3水平呈现上升趋势,而TIP30呈下降趋势。GP73、AFP-L3、TIP30对乙型肝炎源性肝硬化的诊断临界值分别为0.72IU/mL、9.81%、6.89ng/mL,单项TIP30诊断乙型肝炎源性肝硬化的灵敏度、特异度和曲线下面积最高,分别为70.00%(35/50)、67.78%(61/90)和0.747;联合检测GP73、AFP-L3、TIP30诊断乙型肝炎源性肝硬化的灵敏度、特异度及曲线下面积为80.00%(40/50)、75.55%(68/90)和0.767。肝癌组与对照组、肝炎组、肝硬化组血清GP73、AFP-L3、TIP30水平比较,差异均有统计学意义(P<0.01)。GP73、AFP-L3、TIP30对乙型肝炎源性肝癌的诊断临界值分别为1.13IU/mL、12.40%、3.50ng/mL;单项TIP30诊断乙型肝炎源性肝癌灵敏度、特异度和曲线下面积最高,分别为70.00%(35/50)、77.14%(108/140)和0.936;联合检测GP73、AFP-L3、TIP30诊断乙型肝炎源性肝癌灵敏度、特异度及曲线下面积为92.00%(45/50)、91.43%(128/140)和0.977。结论单独检测TIP30对乙型肝炎源性肝硬化和肝癌的诊断价值较高,GP73、AFP-L3、TIP30联合检测可提高诊断价值,用于乙型肝炎源性肝硬化、肝癌辅助检测。

Objective To investigate the value of combined tests of serumgolgi body protein 73 （GP73）,u fetoprotein L3 （AFP L3） and Tat binding protein 30 （TIP30） in the diagnosis of HBV derived hepatocellular carcinoma Hepatitis B cirrhosis. Methods The serum samples of 150 cases of hepatitis B virus carriers were collected, including 50 cases of chronic hepatitis B,50 cases of liver cirrhosis, 50 cases of primary hepatic carci noma,and the serum samples of 40 healthy people were also taken as controls. Serum GP73 and TIP30 levels in each group were detected by using ensyme linked immunosorbent assay （ELISA）. AFP L3 was separated by microspincolumn. The level of AFP L3 in separated eluent and total AFP were quantified by electrochemilumi nescence immunoassays,and the percentage of AFP L3 to AFP was calculated. Results With the process ofchronic hepatitis B to cirrhosis to hepatic carcinoma, GP73 and AFP L3 levels showed a rising trend,while TIP30 level showed a downward trend. The diagnostic thresholds of GP73,AFP L3 and TIP30 for cirrhosis were 0.72 IU/mL,9.81%,6.89 ng/mL respectively. Among single index detection, the sensitivity, specificity and area under ROC curve of TIP30 for diagnosing cirrhosis were the highest,which were 70.00% （35/50）, 67.78% （61/90） and 0. 747 respectively. The sensitivity,specificity and area under ROC curve of combined de tection of GP73,AFP L3 and TIP30 for diagnosing cirrhosis were 80. 00% （40/50）, 75. 55% （68/90） and 0. 767. The levels of serum GP73, AFP L3 and TIP30 in hepatic carcinoma group had significant differences when compared to the control group,chronic hepatitis B group and liver cirrhosis group （P〈0.01）. The diag nostic thresholds of GP73,AFP L3 and TIP30 for hepatocellular carcinoma were 1. 13 IU/mL,12. 40% and 3.50 ng/mL respectively. Among single index detection,the sensitivity, specificity and area under ROC curve of TIP30 for diagnosing primary hepatic carcinoma were the highest,which were 70.00% （35/50）, 77.14% （108/140） and 0. 936 respectively; the sensitivity, specificity and area under ROC curve of combined detection of GP73,AFP L3 and TIP30 for diagnosing primary hepatic carcinoma were 92.00% （45/50） ,91.43% （128/ 140） and 0. 977. Conclusion The single detection of TIP30 has higher diagnostic value for HBV derived hepa tocellular carcinoma and Hepatitis B cirrhosis. The combined detection of GP73, AFP L3 and TIP30 can im prove the diagnostic value and is used in assisting the diagnosis of HBV related liver cancer Hepatitis B cirrho sis.