微小核糖核苷酸-21、异常凝血酶原及甲胎蛋白联合检测在肝细胞癌诊断中的价值

Value of combined detection of micro ribonucleic acid-21,proteins induced by vitamin K absence for factorⅡ,and alpha-fetoprotein in diagnosis of hepatocellular carcinoma

目的探讨微小核糖核苷酸-21(microRNA-21)联合异常凝血酶原(PIVKA-Ⅱ)及甲胎蛋白(AFP)检测对肝细胞性肝癌早期诊断及复发监测的临床价值。方法肝细胞性肝癌组(HCC组)患者54例、肝硬化组(LC组)患者75例和健康体检组(CG组)76例,采集CG组体检时、LC组入院时血液,HCC组术前及术后1、3、6、9及12月时的血液,采用荧光探针法miRNA实时定量PCR技术检测microRNA-21,采用电化学发光法和化学发光法检测PIVKA-Ⅱ及AFP,分析3项指标单独或联合检测对肝癌诊断的价值;分析microRNA-21表达水平与HCC治疗预后的关系、对HCC复发进行单因素和多因素分析。结果HCC组患者microRNA-21、PIVKA-Ⅱ、AFP 3项指标分别高于肝硬化组和对照组指标,差异有统计学意义(P<0.05);3项指标联合检测对HCC的准确度为90.24%,明显高于3项指标单独或两两联合检测的准确度;HCC组microRNA-21高、低表达分层患者术后1、3、6、9及12月随访结果显示microRNA-21高表达组肿瘤复发高于低表达分层,单因素及多因素分析结果显示HCC组肿瘤复发与PIVKA-Ⅱ、microRNA-21、门静脉侵犯、分化程度、微血管侵犯、AJCC分期有关。结论microRNA-21联合PIVKA-Ⅱ、AFP检测可提高肝细胞性肝癌的诊断符合率。

Objective To investigate the clinical value of microRNA-21 combined with proteins induced by vitamin K absence for factorⅡ(PIVKA-Ⅱ)and Alpha-Fetoprotein(AFP)in the early diagnosis and recurrence monitoring of hepatocellular carcinoma(HCC).Methods Patients were divided into three groups:54 patients in hepatocellular carcinoma group(HCC group),75 patients in liver cirrhosis group(LC group)and 76 patients in physical examination group(CG group).The blood of CG group during physical examination and LC group at admission,and the blood of HCC group before operation and 1,3,6,9,and 12 months after operation were collected.MiRNA-21 was detected by fluorescence probe miRNA real-time quantitative PCR;PIVKA-Ⅱand AFP were detected by electrochemiluminescence and chemiluminescence.The value of three indexes in the diagnosis of liver cancer was analyzed.The relationship between the expression level of microRNA-21 and the prognosis of HCC was analyzed,and the recurrence of HCC was analyzed by univariate and multivariate analysis.Results microRNA-21,PIVKA-Ⅱ,and AFP in HCC group were significantly higher than those in liver cirrhosis group and control group(P<0.05).The accuracy of combined detection of three indexes for HCC was 90.24%,which was significantly higher than that of single or two combined detection of three indexes.The follow-up results of patients with high and low expression of microRNA-21 in HCC group at 1,3,6,9,and 12 months after operation showed that the tumor recurrence in high expression group was higher than that in low expression group.Univariate and multivariate analysis showed that the tumor recurrence in HCC group was related to PIVKA-II,microRNA-21,portal vein invasion,degree of differentiation,microvascular invasion,and AJCC stage.Conclusion microRNA-21 combined with PIVKA-II and AFP can improve the diagnostic accuracy of hepatocellular carcinoma.