血清铁蛋白对AFP阴性原发性肝癌患者临床诊断和疗效监控的价值研究

Study on the Value of Serum Ferritin in Clinical Diagnosis and Curative Effect Monitoring in Patients with AFP-Negative Primary Hepatic Carcinoma

目的探讨血清铁蛋白对AFP阴性原发性肝癌(PHC)患者的临床诊断和疗效监控的价值。方法选取2017年1月至2017年12月在我院诊断为原发性肝癌伴AFP阴性的患者78例为观察组,慢性肝炎患者75例为对照组。所有观察组病例均选择肝癌根治性切除术治疗,采用免疫化学发光法检测血清铁蛋白(SF)、癌胚抗原(CEA)、糖类抗原199 (CA199)和α-L-岩藻糖苷酶(AFU),生化酶学速率法检测γ-谷氨酸氨基转移酶(γ-GT)。通过ROC曲线分析SF对于PHC诊断和预测术后PHC复发的临床价值。结果观察组的SF、 AFU、 CEA、 CA199和γ-GT水平分别为(25.24±6.03)μg/mL、(34.61±9.35) U/L、(8.86±1.21) ng/m L、(51.22±10.23) U/mL和(301.23±54.37) U/L,显著高于对照组的(13.12±4.09)μg/mL、(30.29±5.73) U/L、(6.83±0.89) ng/mL、(47.73±10.28) U/mL和(285.55±61.35) U/L (P <0.05)。ROC曲线分析显示SF诊断PHC的AUC面积为0.885 (95%CI:0.794～0.945),敏感性和特异性分别为88.5%和91.2%;联合诊断的AUC面积为0.914(95%CI:0.830～0.965),敏感性和特异性分别为83.6%和93.7%。截止本研究终止, 2例PHC患者失访, 24例出现术后PHC复发,复发率为31.58%;复发组的SF、 AFU、 CEA、 CA199和γ-GT水平显著高于未复发组(P <0.05)。ROC曲线分析显示SF预测术后PHC复发的AUC面积为0.863 (95%CI:0.782～0.937),敏感性和特异性分别为88.4%和90.6%;联合检测的AUC面积为0.905 (95%CI:0.812～0.979),敏感性和特异性分别为81.8%和91.2%。结论血清铁蛋白对于AFP阴性的原发性肝癌患者的临床诊断和预测术后复发具有较高的临床价值,多指标联合检测的效果更好。

Objective To explore the value of serum ferritin (SF) in clinical diagnosis and curative effect monitoring in patients with AFP-negative primary hepatic carcinoma (PHC). Methods 78 cases of patients diagnosed as AFP-negative PHC in our hospital from January 2017 to December 2017 were selected as the observation group, and 75 cases of patients with chronic hepatitis were selected as the control group. All patients in the observation group were treated with radical hepatectomy. The serum ferritin (SF), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199) and α-L-fucosidase (AFU) were detected by immunochemiluminescence, and γ-glutamate aminotransferase (γ-GT) was detected by biochemical rate method. ROC curve was used to analyze the clinical value of SF in diagnosing PHC and predicting PHC recurrence after operation. Results The levels of SF, AFU, CEA, CA199 and γ-GT of the observation group were (25.24 ±6.03)μg/mL,(34.61 ±9.35) U/L,(8.86 ±1.21) ng/mL,(51.22 ±10.23) U/mL and (301.23 ±54.37) U/L respectively, significantly higher than (13.12 ±4.09)μg/mL,(30.29 ±5.73) U/L,(6.83 ±0.89) ng/mL,(47.73 ±10.28) U/mL and (285.55 ±61.35) U/L of the control group, respectively (P <0.05). ROC curve analysis showed that the AUC area of PHC diagnosed by SF was 0.885 (95%CI: 0.794 ~ 0.945), and the sensitivity and specificity were 88.5% and 91.2% respectively;The AUC area of combined diagnosis was 0.914 (95%CI: 0.830 ~ 0.965), and the sensitivity and specificity were 83.6% and 93.7% respectively. At the end of this study, 2 PHC patients had lost visits, and 24 patients had recurrence of PHC after operation, with the recurrence rate of 31.58%. The levels of SF, AFU, CEA, CA199 and γ-GT of the recurrent group were significantly higher than those of non-recurrence group (P <0.05). ROC curve analysis showed that the AUC area of SF in predicting the recurrence of PHC was 0.863 (95%CI: 0.782 ~ 0.937), and the sensitivity and specificity were 88.4% and 90.6% respectively;The AUC area of combined detection was 0.905 (95%CI: 0.812 ~ 0.979), and the sensitivity and specificity were 81.8% and 91.2% respectively. Conclusions Serum ferritin is of high clinical value in the clinical diagnosis of AFP-negative PHC and prediction of postoperative recurrence of PHC, and the combined detection of multiple indicators is more effective.