血清AFP-L3%和GP73检测在AFP低浓度肝癌诊断和鉴别诊断中的应用评价

Evaluation of serum AFP-L3%and GP73 in the diagnosis and differential diagnosis of AFP low concentration liver cancer

目的探讨血清甲胎蛋白异质体比率(AFP-L3%)和高尔基体蛋白73(GP73)单独和联合检测在甲胎蛋白(AFP)低浓度肝癌诊断和鉴别诊断中的应用价值。方法选取中国科技大学附属第一医院2017年1月至2020年1月AFP低浓度肝癌患者42例、乙型肝炎肝硬化失代偿期患者40例、乙型肝炎肝硬化代偿患者44例、慢性乙型肝炎患者43例、乙肝病毒携带者30例及健康体检者30例血清标本,检测AFP、AFP-L3%和GP73的含量,并计算AFP-L3%在AFP中的比率。比较AFP、AFP-L3%和GP73的表达水平和阳性率,通过受试者工作特征曲线(ROC)进行分析,并比较3个指标单项和联合检测的灵敏度、特异度及准确度。结果AFP低浓度肝癌组血清AFP水平与健康组比较差异有统计学意义(P<0.01),与其他各组比较差异无统计学意义;AFP低浓度肝癌组血清GP73水平与乙型肝炎肝硬化代偿组、慢性乙型肝炎组、乙肝病毒携带者组和健康组水平比较差异均有统计学意义(P<0.01),AFP低浓度肝癌组与乙型肝炎肝硬化失代偿组GP73均处于高水平,中位数水平分别为203.75 ng/mL和157.61 ng/mL;单项检测GP73曲线下面积最大为0.807,AFP-L3%联合GP73曲线下面积为0.831;GP73灵敏度、特异度和准确度均高于AFP,AFP-L3%单项检测,AFP-L3%联合GP73检测特异度均高达98.93%;AFP低浓度肝癌组的AFP、AFP-L3%、GP73阳性率与乙肝病毒携带者组和健康组比较均有一定差异;AFP低浓度肝癌组GP73阳性率为71.40%,与其余各组比较均有一定差异。结论GP73单项检测在AFP低浓度肝癌中的诊断价值优于AFP,有利于减少漏诊率;AFP-L3%单项检测或联合GP73检测在AFP低浓度肝癌鉴别诊断中的特异性好,有利于降低误诊率。

Objective To investigate the value of single and combined assay of alpha-fetoprotein L3 ratio(AFP-L3%),Golgi protein 73(GP73)in serum for diagnosis of liver cancer with low concentration of alpha-fetoprotein(AFP).Methods From January 2017 to January 2020,serum samples were collected from 42 patients with low concentration of AFP in liver cancer,40 patients with decompensated hepatitis B cirrhosis,44 patients with compensated hepatitis B cirrhosis,43 patients with chronic hepatitis B,30 patients with hepatitis B virus carriers and 30 healthy people in the First Affiliated Hospital of University of science and technology of China,the contents of AFP,AFP-L3 and GP73 were detected,and the ratio of AFP-L3%in AFP was calculated.The expression levels and positive rates of AFP,AFP-L3%and GP73 were compared.The sensitivity,specificity and accuracy of single and combined detection of the three indicators were analyzed by receiver operating characteristic curve(ROC).Results In serum of liver cancer with low concentration of AFP,AFP level had significant differences(P<0.01)from normal group,but no differences from the other group.Significant differences were found in the assay of GP73 between the group of liver cancer with low concentration of AFP and groups of liver cirrhosis with hepatitis B,chronic hepatitis B,HBV carriers and normal subjects,the difference was statistically significant(P<0.01).Groups of liver cancer with low concentration of AFP and decompensated stage of hepatitis B cirrhosis had high level,the Median were 203.75 ng/ml and 157.61 ng/ml respectively.In single detection,GP73 had the biggest area under the ROC(0.807),the area under AFP-L3%combined GP73 curve was 0.831.Sensitivity,Specificity,Accuracy of GP73 were higher than AFP.Specificity of single detection of AFP-L3%or combination of AFP-L3%and GP73 was up to 98.93%.The positive rates of AFP,AFP-L3%and GP73 in liver cancer with low concentration of AFP were differences from HBV carriers and normal group.Positive rate of GP73 in liver cancer with low concentration of AFP was 71.30%,which was differences from other groups.Conclusion The diagnostic value of GP73 single detection in low concentration AFP liver cancer is better than that of AFP,which is helpful to reduce the rate of missed diagnosis;the specificity of AFP-L3%single detection or combined with GP73 detection in the differential diagnosis of low concentration AFP liver cancer is good,which is helpful to reduce the misdiagnosis rate.