基于决策曲线分析评估血清异常凝血酶原和甲胎蛋白在原发性肝癌中的诊断价值

Diagnostic value of PIVKA-Ⅱ and AFP in patients with primary hepatocellular carcinoma based on decision curve analysis

目的基于决策曲线分析(DCA)及临床影响曲线方法,探讨血清维生素K缺乏诱导的异常蛋白(PIVKA-Ⅱ)和甲胎蛋白(AFP)单独及联合检测在原发性肝细胞癌(HCC)中的应用价值。方法2016年5月至2020年7月于佛山市第一人民医院门诊及住院患者、体检健康者标本共982例并分为肝细胞癌组、肝炎组、肝硬化组、肝胆管癌组、肝继发瘤组及正常对照组共6组,测定受试者血清PIVKA-Ⅱ和AFP水平,采用受试者工作特性曲线(ROC)、DCA及临床影响曲线方法评价PIVKA-Ⅱ和AFP单独及联合检测在HCC中的应用价值。结果肝细胞癌组患者PIVKA-Ⅱ水平和AFP水平均高于其他各组(P<0.001),肝炎组患者PIVKA-Ⅱ水平和AFP水平均高于对照组(P<0.001)。肝细胞癌组、肝炎组及肝硬化组PIVKA-Ⅱ和AFP增高不一致,所占比例分别为35.44%、33.08%、35.43%。以非肝癌者为对照,PIVKA-Ⅱ的曲线下面积(AUC)优于AFP(P<0.001),与联合检测基本一致(P=0.967);以健康人群为对照,两者联合检测AUC优于PIVKA-Ⅱ(P=0.0385),PIVKA-Ⅱ的AUC优于AFP(P<0.001)。结合年龄及性别因素,联合检测对HCC的诊断价值优于AFP,除了风险阈值为0.24~0.25时,联合检测对HCC的诊断价值均优于PIVKA-Ⅱ单独检测。在阈值概率为0.2时,被联合检测方案划分为高风险的人数与真阳性人数基本达到一致。结论血清PIVKA-Ⅱ与AFP均为诊断HCC的良好生物标志物;在进行HCC早期筛查和早期诊断时,应结合患者性别、年龄、PIVKA-Ⅱ及AFP水平等因素进行综合分析。

Objective or antagonist-Ⅱ(PIVKA-Ⅱ)and alpha fetoprotein(AFP)in primary hepatocellular carcinoma(HCC)basing on decision curve analysis(DCA)and clinical impact curve method.Method inpatients and healthy controls in the First People′s Hospital of Foshan were included,and divided into HCC group,chronic hepatitis B group,cirrhosis group,intrahepatic cholangiocarcinoma group,secondary hepatic malignant tumor group and control group.Serum PIVKA-Ⅱand AFP levels were measured.Receiver operating characteristic(ROC),DCA and clinical impact curve were used to evaluate the application value of PIVKA-Ⅱand AFP in patients with HCC.Results than that in other groups(P<0.001).The level of PIVKA-Ⅱand AFP in hepatitis group was significantly higher than that in control group(P<0.001).The proportion that PIVKA-Ⅱand AFP increased inconsistently in HCC group,chronic hepatitis B group,and cirrhosis group was 35.44%,33.08%,and 35.43%,respectively.Taking patients without HCC as control group,the AUC of PIVKA-Ⅱwas better than that of AFP(P<0.001),which was basically consistent with the joint detection(P=0.967).Taking healthy controls as control group,the AUC of joint detection was better than that of PIVKA-Ⅱ(P=0.0385)and the AUC of PIVKA-Ⅱwas better than that of AFP(P<0.001).Combined with age and gender,the diagnostic value of joint detection for HCC was better than that of AFP.Except for the risk threshold of 0.24~0.25,the diagnostic value of combined detection was also better than that of PIVKA-Ⅱ.When the threshold probability was 0.2,the number of people classified as high risk by the joint detection scheme was basically consistent with that of true-positive patients.Conclusion and AFP are good biomarkers for the diagnosis of HCC.In the early screening and diagnosis of HCC,the factors such as patient′s gender,age,PIVKA-Ⅱand AFP level should be taken into consideration in the analysis.