血清甲胎蛋白及其异质体和异常凝血酶原对原发性肝癌的诊断价值

Diagnostic value of serum alpha-fetoprotein, alpha-fetoprotein variant and abnormal prothrombin in primary hepatocellular carcinoma

目的探讨血清肿瘤标志物甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和异常凝血酶原(PIVKA-Ⅱ)单独及其联合检测对原发性肝癌的诊断价值。方法采用化学发光法分别对56例原发性肝癌患者、46例肝硬化患者、45例其他肝病患者及41例健康体检者(对照组)的血清AFP、AFP-L3和PIVKA-Ⅱ进行检测,并比较各组水平差异。用秩和检验和受试者工作特征曲线(ROC曲线)分析。结果原发性肝癌患者血清中AFP、AFP-L3和PIVKA-Ⅱ水平均显著高于肝硬化组、其他肝病组和对照组,差异具有统计学意义(P<0.05)。ROC曲线分析显示:AFP、AFP-L3和PIVKA-Ⅱ单独运用诊断原发性肝癌的曲线下面积分别为0.887、0.846和0.885。三者联合运用诊断原发性肝癌曲线下面积提高为0.899。单项检测中,AFP的敏感度最高,为91.07%,PIVKA-Ⅱ的特异度最高;为88.63%。联合检测中,AFP/PIVKA-Ⅱ组合的敏感度最高,为94.64%;AFP+AFP-L3+PIVKA-Ⅱ组合的特异度最高,为98.48%。结论联合检测AFP、AFP-L3和PIVKA-Ⅱ能提高原发性肝癌诊断特异性和敏感性,弥补单项检测的不足,提高早期诊断率。

Objective To explore the diagnostic value of single or combined detection of serum tumor markers alpha-fetoprotein (AFP),α-fetoprotein (AFP)-L3 and abnormal clotting (PIVKA-II) in the primary hepatic carcinoma. Methods Serum AFP, AFP-L3 and PIVKA-II of 56 cases with primary hepatic carcinoma, 46 cases with cirrhosis, 45 cases with other liver disease and 41 healthy persons (control group) were examined by chemiluminescence method, and the differences in the levels of AFP, AFP-L3 and PIVKA-II in each group were compared. Results Serum level of AFP, AFP-L3 and PIVKA-II in patients with primary liver cancer was significantly higher than that of the cirrhosis, other liver disease and control groups, and the difference was statistically significant (P < 0.05). The receiver operating characteristic curve analysis showed that the areas under the curve for the diagnosis of primary hepatic carcinoma by AFP, AFP-L3 and PIVKA-II were 0.887, 0.846 and 0.885, respectively. The combined use of the three tumor markers for the diagnosis of primary hepatic carcinoma increased the area under the curve to 0.899. Among the single detection, AFP had the highest sensitivity of 91.07% and PIVKA-II had the highest specificity at 88.63%. In the combined detection, AFP/PIVKA-II combination had the highest sensitivity of 94.64 %, while the AFP + AFP-L3 + PIVKA-II combination had the highest specificity at 98.48%. Conclusion Combined detection of AFP, AFP-L3 and PIVKA-II could improve the diagnostic specificity and the sensitivity of primary hepatic carcinoma;thereby make up the deficiency of single detection and improve the early diagnosis rate.