维生素K缺乏或拮抗剂Ⅱ诱导的蛋白对肝细胞癌的诊断价值

The diagnostic value of protein induced by vitamin K deficiency or antagonist Ⅱ in Hepatocellular carcinoma

目的探讨维生素K缺乏或拮抗剂Ⅱ诱导的蛋白(PIVKA-Ⅱ)在肝细胞癌中的诊断价值。方法选取2016年12月~2017年12月间西南医科大学附属医院住院初诊为肝细胞癌(HCC)的患者154例(HCC组)、肝硬化患者126例(肝硬化组)和胃、结肠癌患者153例(胃、结肠癌组),行回顾性分析。检测3组患者的血清PIVKA-Ⅱ和AFP水平,运用受试者工作特性曲线分析PIVKA-Ⅱ和AFP的检测效能,比较两组单独及联合诊断肝癌的敏感度和特异度。结果 HCC组PIVKA-Ⅱ和AFP水平均明显高于肝硬化组及胃、结肠癌组(P<0.001);肝硬化组与胃、结肠癌组AFP水平比较差异有统计学意义(P<0.001),而PIVKA-Ⅱ水平两组比较差异无统计学意义(P>0.05)。HCC组中按肿瘤大小分组发现随着肿瘤直径增大,血清PIVKA-Ⅱ的水平逐渐增高(P<0.001)。按有无门静脉血栓形成、有无远处转移比较,发现有门静脉血栓形成及有远处转移患者PIVKA-Ⅱ、AFP水平均更高(P<0.01)。按巴塞罗那临床肝癌分期,发现不同分期间PIVKA-Ⅱ和AFP的差异均有统计学意义(P<0.01);Spearman秩相关分析显示,在HCC组A、B、C期血清PIVKA-Ⅱ和AFP表达无相关性(P>0.05),但在D期肝癌组中,两项指标的Spearman相关系数具有相关性(P<0.01)。在肝硬化组中,PIVKA-Ⅱ单项检测与PIVKA-Ⅱ、AFP联合检测的ROC-AUC明显高于单一应用AFP检测(P<0.001)。以约登指数确定PIVKA-Ⅱ和AFP的阈值,PIVKA-Ⅱ单项检测的敏感度高于AFP单项检测及联合检测的敏感度(P<0.05),但PIVKA-Ⅱ与联合检测之间的特异度比较差异无统计学意义(P>0.05)。结论血清PIVKA-Ⅱ的检测效能明显优于AFP,可用于HCC的诊断,具有较高的临床应用价值。

Objective To investigate the diagnostic value of protein induced by vitamin K deficiency or antagonist Ⅱ protein induced by vitamin K deficiency or antagonist Ⅱ(PIVKA Ⅱ)in HCC. Methods From December 2016 to December 2017, 154 patients(HCC group), 126 patients with liver cirrhosis(cirrhosis group) and 153 patients with stomach and colon cancer(stomach and colon cancer group) initially diagnosed as HCC in the Affiliated Hospital of Southwest Medical University were selected for retrospective analysis. Serum PIVKA Ⅱ and AFP levels were measured. The detection efficiency of PIVKA Ⅱ and AFP were analyzed by the working characteristic curve of subjects. The sensitivity and specificity of the two groups were compared. Results The levels of PIVKA Ⅱ and AFP in HCC group were significantly higher than those in cirrhosis group, gastric cancer group and colon cancer group(P<0.001). There was a significant difference in AFP level between the cirrhosis group and the stomach and colon cancer group(P<0.001). There was no significant difference in PIVKA Ⅱ between the two groups(P>0.05). In HCC group, the level of PIVKA Ⅱ increased with the increase of tumor diameter(P<0.001). According to the comparison of portal vein thrombosis and distant metastasis, it was found that the levels of PIVKA Ⅱ and AFP were higher in patients with portal vein thrombosis and distant metastasis(P<0.01). According to the clinical stages of liver cancer in Barcelona, the differences of PIVKA Ⅱ and AFP in different periods were statistically significant(P<0.01). Spearman’s rank correlation analysis showed that there was no correlation between the expression of PIVKA Ⅱ and AFP in HCC group(P>0.05). In the group of stage D liver cancer, the Spearman correlation coefficient of the two indexes was correlated(P<0.01). In the cirrhosis group, the ROC AUC detected by PIVKA Ⅱ alone, PIVKA Ⅱ and AFP jointly was significantly higher than that detected by AFP alone(P<0.001). The threshold values of PIVKA Ⅱ and AFP were determined by yoden index. The sensitivity of PIVKA Ⅱ single detection was higher than that of AFP single detection and combined detection(P<0.05). There was no significant difference in the specificity between PIVKA Ⅱ and combined detection(P>0.05). Conclusion The detection efficiency of serum PIVKA Ⅱ is better than that of AFP. It can be used in the diagnosis of HCC and has high clinical application value.