血清AKR1B10和甲胎蛋白联合检测对肝细胞癌诊断的意义

Application of combined serum AFP and AKR1B10 in diagnosis of hepatocellular carcinoma

目的:探讨血清AKR1B10和甲胎蛋白(AFP)联合检测对肝细胞癌(HCC)的临床诊断价值。方法:2015年3月至2018年6月苏州第五人民医院收治的160例HCC患者、160例肝硬化患者、120例慢性乙型肝炎患者、53例自身免疫性肝炎患者、69例药物性肝损伤患者,同期从门诊体检部选取健康体检者120例。用二分类变量Logistic回归进行分析,产生新变量,并对各单项指标、预测概率进行受试者工作特征(ROC)曲线分析,评估单项及联合检测的ROC下面积(AUC)及其敏感性和特异性。结果:HCC组患者的血清AFP和AKR1B10水平均明显高于肝硬化、慢性乙型肝炎、自身免疫性肝炎、药物性肝损伤、健康对照组,差异有统计学意义(P<0.01)。基于Youden指数,AKR1B10判断HCC的cut-off值为903.0 pg/ml,其AUC为0.891,95%CI 0.862-0.920,其敏感性为93.8%,特异性为80.5%;AFP判断HCC的AUC为0.867,95%CI 0.826~0.907。AKR1B10和AFP联合判断HCC的AUC为0.926,95%CI 0.903~0.950,其敏感性为80.0%,特异性为92.5%。另外,AKR1B10诊断早期HCC的AUC为0.893,95%CI 0.854-0.933,其敏感性为93.8%,特异性为81.0%;AKR1B10联合AFP判断早期HCC的AUC为0.916,95%CI 0.880-0.952,敏感性为77.8%,特异性为92.5%。结论:血清AKR1B10和AFP联合检测有助于提高HCC的临床诊断水平,对高危人群的筛查及早期诊断有重要意义。

Objective:To investigate the diagnostic value of combined determination of alpha-fetoprotein(AFP)and AKR1B10.Methods:In total,160 patients with HCC,160 patients with cirrhosis,120 patients with chronic hepatitis B infection,53 patients with autoimmune hepatitis,69 patients with drug-induced liver injuryand 120 healthy controls were selected from the Suzhou Fifth Hospital from January 2013 to December 2017.A new variable predicted probability(p)for HCC was created on the basis of an equation obtained by binary logistic regression and receiver operating characteristics(ROC)was used to evaluate diagnostic accuracy.Results:Serum levels of AFP and AKR1B10 in HCC group were higher than those in other control groups(P<0.001).To identify HCC,area under ROC curve(AUC)of AKR1B10(based on Youden index,cut-off value was 903.0 pg/ml)was 0.891(95%CI[0.862-0.920])with sensitivity 0.938 and specificity 0.805,whilecombined serum AFP and AKR1B10 presented better performance(AUC 0.926[95%CI 0.903-0.950],sensitivity 0.800,specificity 0.925).To identify early HCC,AUC of AKR1B10 was 0.893(95%CI[0.854-0.933])with sensitivity 0.938 and specificity 0.810,while combined serum AFP and AKR1B10 presented better performance(AUC 0.916[95%CI 0.880-0.952],sensitivity 0.778,specificity 0.925).Conclusion:The combine of serum AFP and AKR1B10 shows practical performance for early diagnosis of HCC.