血清维生素K缺乏诱导蛋白Ⅱ检测对原发性肝癌的诊疗价值

The value of serum protein induced by vitamin K absence Ⅱ detection in the diagnosis and treatment of primary hepatocellular carcinoma

目的探讨血清维生素K缺乏诱导蛋白II(PIVKA-Ⅱ)对原发性肝癌(PHC)患者的诊断和疗效评估价值。方法收集安徽省肿瘤医院2014年6月至2017年12月收治的PHC患者(PHC组)和慢性乙型病毒性肝炎后肝硬化患者(乙肝肝硬化组)各60例,同期选取我院60例健康体检者作为对照组。比较3组间血清PIVKA-Ⅱ和甲胎蛋白(AFP)指标水平。计算PIVKA-Ⅱ、AFP及PIVKA-Ⅱ联合AFP诊断PHC的敏感度、特异度,绘制PIVKA-Ⅱ、AFP诊断PHC的ROC曲线图。采用Spearman法分析初诊时PHC组患者血清PIVKA-Ⅱ、AFP水平与肿瘤直径、TNM分期之间的相关性。比较PHC患者治疗前和治疗后血清PIVKAII、AFP水平。结果PHC组患者的血清PIVKA-Ⅱ、AFP水平高于乙肝肝硬化组和健康对照组(P<0.01),乙肝肝硬化组血清AFP水平高于健康对照组(P<0.01),而乙肝肝硬化组与健康对照组血清PIVKA-Ⅱ水平差异无统计学意义(P>0.05)。PIVKA-Ⅱ、AFP诊断PHC的敏感度分别为81.67%、66.67%,特异度分别为90.00%、87.50%;两指标并联敏感度为85.00%,两指标串联特异度为94.17%;PIVKA-Ⅱ、AFP诊断PHC的ROC曲线下面积分别为0.928、0.824。Spearman秩相关分析显示,PHC患者血清PIVKA-Ⅱ、AFP水平与肿瘤直径(r分别为0.642、0.513,P<0.05)和TNM分期均呈正相关(r分别为0.706、0.524,P<0.05)。PHC患者行外科和介入治疗后血清PIVKA-Ⅱ、AFP水平均较治疗前下降(P<0.05)。结论血清PIVKA-Ⅱ、AFP单独检测时,PIVKA-Ⅱ对PHC的诊断效能高于AFP,两指标联合检测可以提高诊断敏感度和特异度。血清PIVKA-Ⅱ、AFP与肿瘤直径、TNM分期呈中等度相关,可作为PHC患者术后疗效的评价指标。

Objective To explore the value of protein induced by vitamin K absence II (PIVKA-Ⅱ) in the diagnosis and efficacy evaluation of primary hepatocellular carcinoma (PHC). Methods A total of 60 patients with PHC (PHC group) and 60 patients with chronic viral hepatitis B cirrhosis (hepatitis B cirrhosis group) treated in Anhui Provincial Carcer Hospital from Jun. 2014 to Dec. 2017 were selected as study object. Another 60 healthy objects were selected as control group. Indexes of serum PIVKA-Ⅱ and AFP among the three groups were compared. Sensitivities and specificities of PIVKA-Ⅱ, AFP, and combination of PIVKA-Ⅱ and AFP were calculated, respectively. The ROC curves of PIVKA-Ⅱ and AFP for PHC were drawn. The correlation between serum levels of PIVKA-Ⅱ, AFP and diameter of tumor, TNM stages were analyzed by Spearman method. Results The serum levels of PIVKA-Ⅱ and AFP in the PHC group were higher than those in the hepatitis B cirrhosis group and control group (P<0.01). The serum level of AFP in the hepatitis B cirrhosis group was higher than that in the control group (P<0.01). The difference of serum PIVKA-Ⅱ between the hepatitis B cirrhosis group and control group was not statistically significant (P>0.05). The sensibilities of serum PIVKA-Ⅱ and AFP for diagnosing PHC were 81.67% and 66.67%, the specificities were 90.00% and 87.50%, respectively. The sensibility of PIVKA-Ⅱ parallel connection with AFP was 85.00%, the specificity of PIVKA-Ⅱ series connection with AFP was 94.17%, the ROC were 0.928 and 0.824, respectively. Spearman rank correlation analysis showed that serum levels of PIVKA-Ⅱ and AFP were positively correlated with diameter of tumor (r=0.642, 0.513, P<0.05), and positively correlated with TNM stages (r=0.706, 0.524, P<0.05). The serum levels of PIVKA-Ⅱ and AFP after treatment were decreased markedly compared with the values before treatment (P<0.05). Conclusion The diagnostic efficiency of PIVKA-Ⅱ for PHC is better than AFP when PIVKA-Ⅱ or AFP is tested separately, and combined detection of PIVKA-Ⅱ and AFP can improve diagnostic sensitivity and specificity. Serum PIVKAII and AFP are moderately correlated with tumor diameter and TNM stage, and can be used as evaluation indexes for postoperative efficacy of PHC.