乙肝相关性肝癌患者血清异常凝血酶原、甲胎蛋白和甲胎蛋白异质体表达水平及临床意义

Expression and clinical significance of abnormal prothrombin, alpha fetoprotein, and alpha fetoprotein heterogeneity in serum of patients with hepatitis B virus-associated hepatocellular carcinoma

目的研究乙肝相关性肝癌患者血清异常凝血酶原(DCP)、甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)表达水平变化及临床意义。方法选取深圳市第三人民医院2018年1月至2020年12月期间接诊的60例乙肝病毒感染相关肝癌患者作为研究组,另选取同期在我院治疗的60例慢性肝硬化患者作为对照组。采用酶联免疫吸附试验检测两组患者血清DCP、AFP、AFP-L3水平,利用诊断试验评价法分析DCP、AFP、AFP-L3单独和联合检测诊断乙肝病毒感染相关肝癌的敏感性、特异性、符合率、Youden指数,并采用Kaplan-Meier分析法分析患者AFP、AFP-L3、DCP表达与预后的相关性。结果研究组患者的DCP、AFP、AFP-L3水平分别为(2153.7±175.7)mAU/mL、(2759.6±264.4)ng/mL、(11.6±4.6)%,明显高于对照组的(32.6±4.7)mAU/mL、(58.4±12.3)ng/mL、(4.8±1.2)%,差异均具有统计学意义(P<0.05);DCP、AFP、AFP-L3两者或三者联合检测诊断乙肝病毒感染相关肝癌的敏感性、特异性、符合率明显高于单独检测,差异均具有统计学意义(P<0.05),且与两者联合检测相比,三者联合检测敏感性、特异性、符合率最高,有利于疾病的有效诊断;采用Kaplan-Meier分析法分析患者AFP、AFP-L3、DCP表达与预后的相关性发现,随着DCP、AFP、AFP-L3蛋白表达升高,患者预后逐渐变差。结论相对于单独诊断,DCP、AFP、AFP-L3联合诊断可有效提高乙肝相关性肝癌的诊断敏感性、特异性和符合率,具有临床应用价值。

Objective To study the changes and clinical significance of serum abnormal prothrombin(DCP),alpha fetoprotein(AFP),and alpha fetoprotein heterogeneity(AFP-L3)in patients with hepatitis B virus-associated hepatocellular carcinoma.Methods Sixty patients with hepatitis B virus-associated hepatocellular carcinoma admitted in Shenzhen Third People's Hospital from January 2018 to December 2020 were selected as the study group,and 60 patients with chronic cirrhosis treated in the hospital at the same time were selected as the control group.The serum levels of DCP,AFP,and AFP-L3 were detected by ELISA,and the sensitivity,specificity,compliance rate,and Youden index of DCP,AFP-L3,and prognosis were analyzed by Kaplan Meier analysis.Results The levels of DCP,AFP,and AFP-L3 in study group were(2153.7±175.7)mAU/mL,(2759.6±264.4)ng/mL,(11.6±4.6)%,significantly higher than(32.6±4.7)mAU/mL,(58.4±12.3)ng/mL,(4.8±1.2)%in the control group(P<0.05).The sensitivity,specificity,and coincidence rate of combined detection of two or three from DCP,AFP,AFP-L3 for diagnosis was significantly higher than those of single detection(P<0.05),and the sensitivity,specificity,and coincidence rate of combined detection of three indexes were higher than those of combined detection of two indexes.Kaplan-Meier analysis was used to analyze the correlation between the expression of AFP,AFP-L3,and DCP and the prognosis of patients,and it was found that with the increase of the expression of DCP,AFP,and AFP-L3 proteins,the prognosis of patients gradually deteriorated.Conclusion Compared with the diagnosis by single index,combined diagnosis of DCP,AFP,and AFP-L3 can effectively improve the diagnostic sensitivity,specificity,and coincidence rate of hepatitis B virus-associated hepatocellular carcinoma,and has significant clinical application value.