维生素K缺乏或拮抗剂-Ⅱ诱导蛋白对乙肝相关性肝癌诊断价值的探讨

The application values of PIVKA-Ⅱin diagnosing the hepatitis-related carcinoma

目的探讨维生素K缺乏或拮抗剂-Ⅱ诱导蛋白(PIVKA-Ⅱ)在诊断乙肝相关性肝癌中的应用价值,为临床应用提供实验依据。方法检测凝血功能无异常的60例健康体检者、60例乙肝相关良性疾病者和178例乙肝相关性肝癌患者血清中PIVKA-Ⅱ和甲胎蛋白,采用ROC曲线分析两者单独及联合运用在诊断乙肝相关性肝癌方面的价值。结果乙肝相关性肝癌患者血清PIVKA-Ⅱ明显高于健康对照组、肝良性疾病组(P<0.05),ROC曲线下面积为0.940;与AFP二者联合检测乙肝相关性肝癌的敏感度为96%,特异性为63%,两者联合的曲线下面积为0.947。结论PIVKA-Ⅱ对于乙肝相关性肝癌具有诊断价值,其与AFP联合检测对于诊断乙肝相关性肝癌方面更具优势,但单独检测对于血清中AFP水平正常的高危患者更具成本效益。

Objective To investigate the value of abnormal prothrombin in the diagnosis of hepatitis B related hepatocellular carcinoma(HCC)and provide experimental evidence for its clinical application.Methods The serum levels of PIVKA-Ⅱand alpha-fetoprotein in healthy subjects,hepatitis B-related benign diseases,and hepatitis B related hepatocellular carcinoma were measured,which had no abnormal coagulation function.ROC curves were used to analyze the value of the two methods in combination and unitaryin the diagnosis of hepatitis B related hepatocellular carcinoma.Results PIVKA-Ⅱwas significantly higher in patients with hepatitis B related hepatocellular carcinoma than in healthy controls and benign liver diseases(P<0.05).The area under the ROC curve was 0.940;the sensitivity of the combined detection of AFP and hepatitis B was 94.9%,the specificity was 68.3%.The area under the curve of the combination was 0.947.Conclusion PIVKA-Ⅱhas diagnostic value for hepatitis B related HCC,and its combined detection with AFP is more advantageous for the diagnosis of hepatitis B related HCC.For diagnostic use,PIVKA-Ⅱis most cost-effective in at-risk patients with normal levels of AFP in serum.