AFP、AFP-L3及PIVKA-Ⅱ单项及联合诊断在HCC中的临床意义

AFP,AFP-L3,and PIVKA-Ⅱand combination of them in diagnosis of hepatocellular carcinoma

目的比较甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)及异常凝血酶原-Ⅱ(PIVKA-Ⅱ)单项和联合指标诊断肝细胞癌(HCC)的临床意义。方法选择盱眙县人民医院2019年2月1日至2020年10月30日就诊于肿瘤科或感染科或普外科的HCC患者13例,设为HCC组。对照组选取同期时间段就诊于肿瘤科或感染科或普外科的良性肝病患者,作为良性肝病103例,其中肝硬化相关疾病组84例,乙型肝炎相关疾病组19例。比较3组患者的一般资料、AFP、AFP-L3、PIVKA-Ⅱ水平及阳性率。结果HCC组、肝硬化组和乙型肝炎组男性百分比分别为61.5%(8/13)、58.3%(49/84)和68.4%(13/19),3组对比差异无统计学意义(χ^(2)=0.667,P>0.05)。HCC组、肝硬化组和乙型肝炎组年龄分别为(67.30±12.44)岁、(59.38±9.88)岁、(50.84±11.26)岁,3组对比差异有统计学意义(P<0.05)。HCC组AFP、AFP-L3及PIVKAⅡ水平分别为56.70(2.65,3096.80)μg/L、27.60(3.90,62.10)%、918.00(28.00,51537.50)mAu/ml,肝硬化组分别为3.30(2.53,7.80)μg/L、0.50(0.50,6.45)%、14.00(11.00,20.75)mAu/ml,乙型肝炎组分别为6.20(2.40,32.90)μg/L、2.80(0.50,8.50)%、16.00(10.00,21.00)mAu/ml,HCC组AFP、AFP-L3及PIVKA-Ⅱ水平均高于肝硬化组和乙型肝炎组(均P<0.05)。HCC组AFP、AFP-L3及PIVKA-Ⅱ阳性率分别为61.5%(8/13)、69.2%(9/13)、69.2%(9/13),肝硬化组分别为22.6%(19/84)、15.5%(13/84)、17.9%(15/84),乙型肝炎组分别为31.6%(6/19)、15.8%(3/19)、10.5%(2/19),3组AFP、AFP-L3及PIVKA-Ⅱ阳性率对比差异均有统计学意义(均P<0.05)。AFP、AFP-L3及PIVKA-Ⅱ单项指标曲线下面积(AUC)分别为0.681(95%CI 0.496~0.864)、0.786(95%CI 0.628~0.944)和0.869(95%CI 0.773~0.964)。其中单独诊断PIVKA-Ⅱ的AUC最大,性能最佳。联合检测效能大于单独检测,其中AFPL3+PIVKA-Ⅱ或者AFP+AFP-L3+PIVKA-Ⅱ方案最好。结论AFP、AFP-L3及PIVKA-Ⅱ联合诊断可以提高HCC的检测率,降低漏诊率。

Objective To explore the clinical significance of alpha-fetoprotein(AFP),alpha-fetoprotein heterogene(AFP-L3),and abnormal prothrombinⅡ(PIVKAⅡ)and the combination of them in the diagnosis of hepatocellular carcinoma(HCC).Methods Thirteen HCC patients who were treated at Xuyi People's Hospital from February 1,2019 to October 30,2020 were selected as an HCC group.One hundred and three patients with benign diseases who were treated in the departments of oncology,infection,or general surgery during the same period were selected as a control group;of which,there were 84 cases in the cirrhosis group and 19 cases in the hepatitis B group.The general data,the levels of AFP,AFP-L3,and PIVKAⅡ,and the positive rates were compared between these 3 groups.Results The male percentage was 61.5%(8/13)in the HCC group,58.3%(49/84)in the cirrhosis group,and 68.4%(13/19)in the hepatitis B group(χ^(2)=0.667,P>0.05).The HCC group was(67.30±12.44)years old,the cirrhosis group(59.38±9.88),and the hepatitis B group(50.84±11.26)(P<0.05).The levels of AFP,AFP-L3,and PIVKAⅡwere 56.70(2.65,3096.80)μg/L,27.60(3.90,62.10)%,and 918.00(28.00,51537.50)mAu/ml in the HCC group,were 3.30(2.53,7.80)μg/L,0.50(0.50,6.45)%,and 14.00(11.00,20.75)mAu/ml in the cirrhosis group,andwere 6.20(2.40,32.90)μg/L,2.80(0.50,8.50)%,and 16.00(10.00,21.00)mAu/ml in the hepatitis B group,with statistical differences between the HCC group on one hand and the cirrhosis group and the hepatitis B group on the other hand(all P<0.05).The positive rates of AFP,AFP-L3,and PIVKA-Ⅱwere 61.5%(8/13),and 69.2%(9/13),and 69.2%(9/13)in theHCC group,were 22.6%(19/84),15.5%(13/84),and 17.9%(15/84)in the cirrhosis group,and were 31.6%(6/19),15.8%(3/19),and 10.5%(2/19)in the hepatitis B group(all P<0.05).The areas under the curves(AUC)of AFP,AFP-L3,and PIVKA-Ⅱwere 0.681(95%CI 0.496-0.864),0.786(95%CI 0.628-0.944),and 0.869(95%CI 0.773-0.964).Among them,the AUC of PIVKAⅡwas the biggest,and the performance was the best.The combined detection had greater efficiency than the single detections,and AFPL3+PIVKA-Ⅱand AFP+AFPL3+PIVKA-Ⅱwere the best.Conclusion The combination of AFP,AFP-L3,and PIVKA-Ⅱcan increase the detection rate of HCC and reduce the missed diagnosis rate.