甲胎蛋白异质体L3对早期原发性肝癌的诊断价值

Diagnostic value of alpha-fetoprotein heterogeneity L3 on early primary liver cancer

目的探讨甲胎蛋白异质体L3(alpha-fetoprotein heterogeneity L3,AFP-L3)对早期原发性肝癌(primary liver cancer,PLC)的诊断价值。方法选取2016年1月至2016年12月于首都医科大学附属北京地坛医院住院的150例患者为研究对象,其中慢性肝炎(chronic hepatitis,CH)患者32例(慢性乙型肝炎患者26例,慢性丙型肝炎患者6例)、肝硬化(liver cirrhosis,LC)患者45例,早期PLC患者73例,比较各组患者的AFP及AFP-L3%水平并进行相关性分析。结果 PLC组患者AFP-L3%为(19.70±13.47)%,显著高于肝硬化组[(9.57±5.28)%]与慢性肝炎组[(7.85±4.41%)],差异有统计学意义(F=8.661,P=0.001)。在所有患者中,AFP> 20 ng/ml诊断早期PLC的敏感性、特异性、阳性预测值、阴性预测值分别为67.1%(49/73)、62.3%(48/77)、62.8%(49/78)和66.7%(48/72);AFP-L3%> 10%诊断早期PLC的敏感性、特异性、阳性预测值、阴性预测值分别为72.6%(53/73)、83.1%(64/77)、80.3%(53/66)和76.2%(64/84),AFP-L3%诊断早期PLC的特异性和阳性预测值均显著高于AFP,差异有统计学意义(χ2=5.271、4.390,P=0.028、0.047)。结论AFP-L3%诊断早期PLC的特异性及阳性预测值显著高于AFP,对早期PLC的诊断及鉴别诊断具有重要意义。

Objective To investigate the diagnostic value of alpha-fetoprotein heterogeneity L3(AFP-L3)on early primary liver cancer(PLC).Methods A total of 150 patients in Beijing Ditan Hospital,Capital Medical University from January 2016 to December 2016 were selected.There were 32 patients with chronic hepatitis(CH)(26 cases were with chronic hepatitis B and 6 cases were with chronic hepatitis C),45 patients with liver cirrhosis(LC)and 73 patients with early PLC.AFP and AFP-L3%were compared among different groups.The correlation between AFP and AFP-L3%was also analyzed.Results AFP-L3%of patients in early PLC group was(19.70±13.47)%,which was significantly higher than those in LC group[(9.57±5.28)%]and CH group[(7.85±4.41)%],the differences were statistically significant(F=8.661,P=0.001).In all patients,the sensitivity,specificity,positive predictive value and negative predictive value of AFP>20 ng/ml on early PLC were 67.1%,62.3%,62.8%and 66.7%,respectively.The sensitivity,specificity,positive predictive value and negative predictive value of AFP-L3%>10%on early PLC were 72.6%,83.1%,80.3%and 76.2%,respectively.The specificity and positive predictive value of AFP-L3%were significantly higher than those of AFP(χ^2=5.271,4.390;P=0.028,0.047).Conclusions The specificity and predictive positive rate of AFP-L3%in the diagnosis of early primary liver cancer were higher than those of AFP.AFP-L3%played an important role in the diagnosis and differential diagnosis of early primary liver cancer.