外周血NLR联合血清AFP、GP73、DKK1检测对原发性肝癌的诊断价值

Diagnostic value of peripheral blood NLR combined with serum AFP,GP73 and DKK1 in primary hepatocellular carcinoma

目的:探讨外周血中性粒细胞和淋巴细胞比值(NLR)联合血清甲胎蛋白(AFP)、高尔基体蛋白73(GP73)、Dickkopf同源物1(DKK1)水平对原发性肝癌(PHC)的诊断价值。方法:选取2018年6月至2019年6月本院收治的PHC患者110例作为PHC组,肝硬化(LC)患者90例作为LC组,慢性乙肝(CHB)患者90例作为CHB组,及健康体检者90例作为对照组。使用全自动血细胞分析仪(URIT-3060型)测定中性粒细胞(Neu)、淋巴细胞(Ly)数量,计算得出NLR;使用双抗体夹心酶联免疫吸附法(ELISA)检测血清AFP、GP73、DKK1水平。比较四组受试者NLR及血清AFP、GP73、DKK1水平,分析其与PHC患者TNM分期关系,并通过ROC曲线分析四者单独及联合检测对PHC的诊断价值。结果:各组受试者NLR及血清AFP、GP73、DKK1水平高低依次为PHC组患者、LC组患者、CHB组患者、对照组,组间两两比较差异均有统计学意义(P<0.05)。PHC患者TNM不同分期间NLR及血清AFP、GP73、DKK1水平高低依次为Ⅳ期、Ⅲ期、Ⅱ期、Ⅰ期,组间两两比较差异均有统计学意义(P<0.05)。ROC曲线结果显示,NLR及血清AFP、GP73、DKK1水平诊断PHC的曲线下面积分别为0.859、0.698、0.775、0.901,最佳截断值分别为10.25、12.39 ng/mL、115.87 ng/mL、5.36 ng/mL,敏感度分别为75.70%、61.40%、65.70%、85.70%,特异性分别为85.70%、71.40%、78.60%、80.00%;而NLR联合血清AFP、GP73、DKK1水平诊断PHC的曲线下面积为0.941,敏感度为88.60%,特异性高达92.90%,诊断效能优于四者单独诊断。结论:PHC患者外周血NLR及血清AFP、GP73、DKK1水平明显升高,四者联合检测可提高对PHC的诊断效能。

Objective:To investigate the diagnostic value of peripheral blood neutrophil to lymphocyte ratio(NLR)combined with serum alpha fetoprotein(AFP),Golgi protein 73(GP73)and Dickkopf-1(DKK1)levels in primary hepatocellular carcinoma(PHC).Methods:110 patients with PHC admitted to our hospital from June 2018 to June 2019 were selected as PHC group,90 patients with liver cirrhosis(LC)as LC group,90 patients with chronic hepatitis B(CHB)as CHB group,and 90 healthy people as control group.The number of neutrophils(Neu)and lymphocytes(Ly)was measured by automatic hematology analyzer(URIT-3060),and the NLR was calculated.The serum levels of AFP,GP73 and DKK1 were detected by double antibody sandwich enzyme-linked immunosorbent assay(ELISA).The levels of NLR and serum AFP,GP73,DKK1 were compared among the four groups.The relationship between NLR and TNM staging in PHC patients was analyzed.The diagnostic value of single and combined detection of NLR and serum AFP,GP73 and DKK1 in PHC patients was analyzed by ROC curve.Results:The levels of NLR and serum AFP,GP73 and DKK1 in each group were in turn PHC group,LC group,CHB group and control group.There were significant differences between the two groups(P<0.05).The levels of NLR and serum AFP,GP73 and DKK1 in different stages of TNM in PHC patients were in the order of stageⅣ,Ⅲ,ⅡandⅠ.There were significant differences between the two groups(P<0.05).The results of ROC curve showed that the area under the curve of NLR and serum AFP,GP73 and DKK1 levels in diagnosing PHC was 0.859,0.698,0.775 and 0.901,respectively.The best cut-off values were 10.25,12.39 ng/mL,115.87 ng/mL and 5.36 ng/mL.The sensitivity was 75.70%,61.40%,65.70%,85.70%.Specificity was 85.70%,71.40%,78.60%and 80.00%,respectively.The area under the curve of NLR combined with serum AFP,GP73 and DKK1 levels was 0.941.The sensitivity was 88.60%,and the specificity was 92.90%.The diagnostic efficiency of NLR combined with serum AFP,GP73 and DKK1 levels was better than that of single diagnosis of PHC.Conclusion:The levels of NLR in peripheral blood and AFP,GP73 and DKK1 in serum of patients with PHC are significantly increased.The combined detection of the four can improve the diagnostic efficiency of PHC.