血清甲胎蛋白、白细胞介素-6和高尔基体蛋白73在肝脏疾病中的表达特点及其对肝细胞癌的诊断价值

Pattern of serum α-fetal protein, intereleukin-6 and Golgi protein 73 expressed in liver diseases and their diagnostic value on hepatocellular carcinoma

目的探讨血清甲胎蛋白(AFP)、白细胞介素-6(IL-6)和高尔基体蛋白73(GP73)在肝病中的表达特点及对HBV相关原发性肝癌(PHC)的临床诊断价值。方法选择2015年1月至2016年3月于解放军第一八〇医院肝病中心住院的慢性HBV感染者共391例为研究对象,采用全自动电化学发光免疫分析仪和酶联免疫法分别检测患者血清AFP、IL-6与GP73的表达水平,分析这3种血清标志物对PHC的诊断价值。结果 CHB、乙型肝炎肝硬化(HLC)、PHC三组人群中,血清IL-6和GP73水平随病情加重而逐渐升高(P均<0.05),失代偿期HLC组血清IL-6和GP73水平显著高于代偿期组(P均<0.001),AFP表达水平于PHCⅡ期、Ⅲ期患者中显著升高(Z=3.305、P=0.001,Z=2.902、P=0.003),血清IL-6和GP73水平随肝细胞癌等级升高而升高(P均<0.05)。血清IL-6与GP73呈对数正相关(r=0.553,P<0.001)。3种血清标志物诊断PHC的曲线下面积分别为0.788、0.787和0.649。AFP+IL-6联合患者组曲线下面积为0.873,敏感性显著升高,与AFP相比差异具有统计学意义(χ~2=49.891、P<0.001)。AFP+IL-6+GP73联合组与AFP+IL-6联合组诊断价值差异无统计学意义(Z=1.256、P=0.209)。IL-6与GP73对失代偿期肝硬化和肝细胞癌的鉴别诊断价值不高,曲线下面积均低于0.6。结论 IL-6可作为AFP诊断肝癌的补充预测因子,而GP73对肝癌的诊断价值不高。

Objective To investigate the pattern of serumα-fetal protein(AFP),intereleukin-6(IL-6)and Golgi protein73(GP73)expressed in liver diseases and the diagnostic value on hepatitis B virus related primary hepatic carcinoma(PHC).Methods Total of391patients with HBV in the180th Hospital of PLA,from January2015to March2016were collected.AFP and IL-6were detected by automatic electrochemical luminescence immunity analyzer.GP73was detected by ELISA.Their diagnostic value for the PHC were analyzed by ROC analysis.Results Among chronic hepatitis B(CHB)group,HLC group and PHC group,the level of serum IL-6and GP73significantly increased when the disease worsened(P<0.05).Compared with the compensated HLC group,the serum level of them showed higher in decompensated group(P<0.001).The expression of AFP were significantly increased in stageⅡandⅢof PHC compared with stageⅠ(Z=3.305,P=0.001;Z=2.902,P=0.003).The level of serum IL-6and GP73significantly increased when the stage of PHC rising(P<0.05).There was positive logarithmic correlation between IL-6and GP73(r=0.553,P<0.001).The area under the ROC curve of AFP,IL-6and GP73for diagnosing PHC were0.788,0.787and0.649,respectively.When taking AFP and IL-6as predictors together,the area was0.873and the sensitivity was significantly higher than AFP(χ2=49.891,P<0.001).There was no difference between combined group of AFP+IL-6+GP73and AFP+IL-6in diagnosing PHC(Z=1.256,P=0.209).IL-6and GP73could not distinguish decompensated HLC from hepatocellular carcinoma,their area under the ROC curve were both less than0.6.Conclusions AFP and IL-6could serve as a complementary factor to predict the occurrence of PHC,while the value of GP73in diagnosing PHC was not high.