CMIA法测定血清DCP与AFP对肝细胞癌的诊断价值

Diagnostic Value of the Serum DCP and AFP Determined by CMIA in Hepatocellular Carcinoma

目的分析治疗前血清异常凝血酶原(DCP)和甲胎蛋白(AFP)在肝细胞癌(HCC)中的鉴别诊断价值。方法采用微粒子化学发光免疫分析法(CMIA)测定2017年6月～2018年4月南通市第三人民医院住院的HBV感染相关的HCC患者110例(HCC组)、肝硬化(LC组)54例和慢性乙型肝炎(CHB组)63例治疗前血清DCP和AFP水平。两两比较采用Mann-Whitney U检验,多组比较采用Kruskal-Wallis H检验,率的比较采用χ~2检验,Spearman秩相关分析DCP与AFP相关性,分析DCP和AFP诊断HCC受试者工作曲线下面积(ROC-AUC)、灵敏度及特异度。结果 HCC组DCP和AFP水平均显著高于LC组和CHB组(Z=-8.75,-4.89,-9.24和-5.37,均P<0.001)。DCP与AFP水平在LC组与CHB组间差异均无统计学意义(Z=-0.558,-0.077;P=0.577,0.939)。当对照组分别设为LC+CHB及LC组时,DCP诊断HCC的ROC-AUC均显著大于AFP(0.922vs 0.741,Z=4.56;0.921vs 0.735,Z=4.15,均P<0.001)。当对照组设为LC+CHB时,DCP诊断HCC的敏感度和特异度均显著高于AFP(88.18%vs 58.18%,χ~2=25.22;92.31%vs 75.21%,χ~2=12.57,均P<0.001)。DCP/AFP方案不能提高诊断HCC的敏感度(χ~2=1.98,P=0.159)。DCP+AFP方案对诊断HCC的特异度有所提高(P=0.019)。当对照组设为LC组时,DCP诊断HCC的特异度显著高于AFP(94.17%vs 72.22%,χ~2=4.79,P<0.05)。DCP与AFP具有弱相关性(r=0.367)。DCP与肿瘤大小呈正相关(r=0.633)。结论 DCP与AFP相比有较高的敏感度和特异度,两者联合检测能够提高HCC患者的检出率。

Objective To evaluate the diagnostic value of the Des gamma carboxyprothrombin （DCP） and alpha fetoprotein （AFP） of serum from hepatocellular carcinoma （HCC） patients before therapy. Methods Chemiluminescent Microparticle Immunoassay （CMIA） was used to determined the serum DCP and AFP level ftom patients with HBV associated HCC （n= 110） ,liver cirrhosis （LC, n=54） and chronic hepatitis B （CHB, n=63） from June 2017 to April 2018 in the Third People＇s Hospital of Nantong. Two independent groups were analyzed by the Mann Whitney U test. The difference among multi groups was analyzed by the Kruskal Wallis U test. The rate comparison was analyzed by the chi square test. The correlation between DCP and AFP was analyzed by the Spearman rank correlation analysis. Morever, the area under the receiver operat ing characteristic curve （ROC AUC）, sensitivity and specificity of DCP or AFP in differentiating HCC were analyzed. Results The DCP and AFP levels in patients with HCC were significantly higher than those of patients with LC and CHB （Z=- 8.75, 4.89 and 9.24, 5.37,all P〈0. 001）. There was no significant difference in the level of DCP and AFP between LC and CHB groups （Z=- 0. 558, 0. 077, P=0. 577,0. 939）. When the control group was set as LC＋CHB and LC group respectively, the ROC AUC of DCP in the diagnosis of HCC was significantly greater than that of AFP （0. 922 vs 0. 741, Z =-4.56;0. 921 vs 0. 735,Z=-4.15,all P〈0. 001）. When the control group was set as LC＋CHB,the sensitivity and specificity of DCP in the diagnosis of HCC were significantly higher than that of AFP （88.18% vs 58.18% , x2 =25.22 and 92.31% vs 75.22% , X2 =22.57 ,all P〈 0.00]）. DCP/AFP cannot improve the sensitivity in the diagnosis of HCC （x2=1. 98, P= 0. 259）. DCP＋AFP could improve the specificity in the diagnosis of HCC （P=0. 019）. When the control group was set up as LC, the specificity of DCP in diagnosing HCC was still significantly higher than that of AFP （94.27 % vs 72.22 % , X2= 4.79, P〈0.05）. There was a weak correlation between the level of serum DCP and AFP （r=0. 367）. There was a positive correlation between the level of serum DCP and tumor size （r=0. 633）. Conclusion DCP had higher sensitivity and specific ity in the diagnosis of HCC than AFP. Combined detection of DCP and AFP can improve the diagnostic rate of HCC pa dents.