尿素、α-L-岩藻糖苷酶、甲胎蛋白联合检测在慢性乙型肝炎-肝硬化-肝癌发展中的应用价值

The application value of combination detection of Urea,AFU and AFP in the process of hepatitis B-liver cirrhosis-HCC

目的探讨尿素(Urea)、甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)联合检测在慢性乙型肝炎-肝硬化-肝癌发展中的应用价值。方法收集2017年9月-2018年1月在温州医科大学附属第二医院就医的194例患者,其中包括慢性乙型肝炎组(82例)、肝硬化组(54例)、肝癌组(58例)、正常对照组(92例)。检测Urea、AFP、AFU水平,比较各组各指标水平差异,并针对是否患慢性乙型肝炎相关性肝病,慢性乙型肝炎病情是否发展及是否患原发性肝细胞癌(HCC)3方面,分别绘制单独检测指标ROC曲线,根据最大约登指数确定最佳临界值并得到其灵敏度及特异度,再通过Logistic回归,统计分析2项及3项指标联合检测结果,绘制联合诊断ROC曲线,计算曲线下面积(AUC)并与单独检测结果相比较,最终确定各检测指标在慢性乙型肝炎-肝硬化-肝癌发展中的应用价值。结果肝癌组Urea、AFU、AFP水平均高于正常对照组及慢性乙型肝炎组(P<0.05),且AFP水平明显高于肝硬化组(P<0.05)。在诊断是否患慢性乙型肝炎相关性肝病及慢性乙型肝炎病情是否发展上,AFU与AFP联合检测诊断效能最高(AUC分别为0.771、0.748)。在鉴别诊断HCC上,Urea、AFU及AFP联合检测诊断效能最高(AUC=0.835)。结论Urea、AFU与AFP联合检测可提高HCC鉴别诊断效能,具有较好的临床应用价值。

Objective To evaluate the application value of combination detection of Urea,AFU and AFP in the process of hepatitis B-liver cirrhosis-HCC.Methods A total of 194 patients hospitalized in the Second Hospital Affiliated to Wenzhou Medical University from September 2017 to January 2018 were collected,including 82 patients in the chronic hepatitis B group,54 patients in the cirrhosis group,58 patients in the liver cancer group,and 92 cases in the control group.The levels of urea(Urea),alpha-fetoprotein(AFP),andα-L-fucosidase(AFU)were detected;the differences in the levels of indicators in each group were compared;and according to whether having chronic hepatitis B-related liver disease,whether the condition of chronic hepatitis B is progressing,whether having primary hepatocellular carcinoma(HCC),the ROC curve of the individual detection indicators was drawn respectively.The area under the curve(AUC)was calculated and compared with the individual test results to determine the application value of each test indicator in the development of chronic hepatitis B-cirrhosis-liver cancer.Results The levels of Urea,AFU and AFP in the HCC group were higher than those in the control group and the hepatitis B group(P<0.05),and the AFP level in HCC is significantly higher than in cirrhosis group(P<0.05).In the diagnosis of HBV-related liver disease,the diagnosis value of combined detection of AFU and AFP was the highest;in the detection of the development of HBV,combined detection of Urea and AFP improved the diagnosis value of single detection;in the differential diagnosis of HCC,the diagnosis value of combined detection of Urea,AFU and AFP was the highest.Conclusion The combined detection of Urea,AFU and AFP can improve the differential diagnosis efficacy of HCC,and has good clinical application value.