血清婆罗双树样基因-4联合AFP在原发性肝癌诊断中的应用价值

The clinical efficacy of SALL4 combined with AFP in the diagnosis of primary hepatic carcinoma

目的:观察原发性肝癌(PHC)患者血清婆罗双树样基因-4(SALL4)表达水平,并探讨血清SALL4联合甲胎蛋白(AFP)在诊断PHC中的临床效能。方法:纳入2019年1月至2019年12月于南阳市中心医院就诊的70例PHC患者、40例乙型肝炎肝硬化(LC)患者和35例健康体检者作为研究对象。于清晨空腹抽取所有研究对象的外周静脉血5 ml,ELISA法检测并比较3组对象血清SALL4表达水平的差异,分析PHC患者血清SALL4表达水平与临床-病理特征的关系,PHC患者血清SALL4表达水平的影响因素采用多因素分析,利用受试者工作特征曲线(ROC)探讨血清SALL4联合AFP在诊断PHC中的临床效能。结果:对照组、LC组和PHC组人群血清SALL4表达水平两两比较均差异有统计学意义(P<0.05);PHC组患者血清SALL4表达水平与分化程度、TNM分期、Child-Pugh分级及淋巴结转移显著相关。Logistic回归分析显示,TNM分期、淋巴结转移、Child-Pugh分级均是PHC患者血清SALL4水平升高的危险因素。ROC曲线结果发现,血清SALL4表达水平诊断PHC的AUC为0.836(95%CI 0.753~0.872),当截断值为104.23 pg/ml时,敏感度和特异度分别为92.51%和76.94%;血清AFP表达水平诊断PHC的AUC为0.744(95%CI 0.623~0.791),当截断值为168.72 ng/ml时,敏感度和特异度分别为93.24%和63.16%;SALL4联合AFP诊断PHC的AUC为0.915(95%CI 0.863~0.957),敏感度和特异度分别为95.18%和90.04%。结论:PHC患者血清SALL4表达水平显著升高,SALL4联合AFP诊断PHC的临床效能显著,SALL4可作为PHC患者的一项血清学肿瘤标志物。

Objective:To explore the serum SALL4 level in patients with primary hepatic carcinoma(PHC)and to determine the clinical efficacy of combined detection of SALL4 and AFP in the diagnosis of PHC.Methods:A total of 70 patients with PHC,40 patients with(liver cirrhosis,LC)and 35 healthy people between January.2019 and December.2019 in Nanyang Central Hospital were included in this study as PHC group,LC group and healthy control group,respectively.About 5ml of peripheral venous blood was taken from all subjects under an empty stomach in the morning and the serum SALL4 level were detected by ELISA methods and compared between the three groups.The relationship between serum SALL4 level and cliniacl-pathological characteristics of patients with PHC were analyzed.The influencing factors of serum SALL4 level in patients with PHC were analyzed by Logsitic regression analysis.The clinical efficacy of SALL4 combined with AFP in the diagnosis of PHC was analyzed by receiver operating characteristic(ROC)curve.Results:There was a significant difference in the level of SALL4 between the control group,LC group and PHC group(P<0.05).When compared with the control group,the level of SALL4 in LC group and PHC group was significantly higher(P<0.05).The level of SALL4 in PHC group was also significantly higher than the LC group(P<0.05).The serum SALL4 level in patients with PHC was significant related to the degree of tumor cell differentiation(t=-3.860,P<0.000),TNM stage(t=-8.136,P<0.000),Child class(t=-7.148,P<0.000)and lymph node metastasis(t=-10.237,P<0.000).Logistic regression analysis results showed that TNM stage(OR=3.258),lymph node metastasis(OR=8.543)and Child grade(OR=2.156)were the risk factors for the increased SALL4 level in patients with PHC.When the optimal cut-off value of SALL4 was 104.23 pg/ml,the AUC was 0.836(95%CI:0.753~0.872),and the sensitivity and specificity were 92.51%and 76.94%,respectively.When the optimal cut-off value of AFP was 168.72 ng/ml,the AUC was 0.744(95%CI:0.753~0.872),and the sensitivity and specificity were 93.24% and 63.16%,respectively.The AUC of joint detection of serum SALL4 and AFP levels was 0.915(95%CI:0.863~0.957),and the sensitivity and specificity were 95.18%and 90.04%,respectively.Conclusion:The levels of SALL4 in patients with PHC was significantly higher.The clinical efficacy of SALL4 combined with AFP in the diagnosis of PHC is significant.SALL4 is a potential serological tumor marker in patients with PHC.