甲胎蛋白、甲胎蛋白异质体比例和异常凝血酶原联合应用在肝癌诊断中的临床意义

Clinical significance of combined application of alpha-fetoprotein,alpha-fetoprotein-L3%and des-gamma-carboxy-prothrombin in the diagnosis of hepatocellular carcinoma

[目的]探讨甲胎蛋白(AFP)、甲胎蛋白异质体比例(AFP-L3%)及异常凝血酶原(DCP)联合应用在肝癌诊断中的价值.[方法]采用全自动化学发光免疫分析仪对126例肝癌患者和307例普通肝病患者(肝硬化158例,慢性乙型肝炎149例)血清中的AFP、AFP-L3%和DCP含量进行检测并进行分析比较.[结果]AFP、AFP-L3%和DCP水平在慢性乙型肝炎组、肝硬化组和肝癌组中逐渐升高,慢性乙型肝炎组和肝硬化组与肝癌组间差异均具有统计学意义(P<0.01);在AFP<7μg/L、7μg/L≤AFP<200μg/L和AFP≥200μg/L 3组中,肝癌患者AFP-L3%和DCP水平逐渐升高,两两组间比较差异具有统计学意义(P<0.01);肝硬化组和慢性乙型肝炎组DCP和AFP-L3%间差异均无统计学意义(P>0.05).DCP在肝癌诊断中的敏感性优于AFP和AFP-L3%,AFP-L3%在肝癌诊断中的特异性优于AFP和DCP;3项联合诊断的敏感性优于单一的血清学指标诊断.[结论]AFP-L3%、DCP和AFP在应用于肝癌诊断中时具有互补作用,联合检测可提高肝癌的诊断率.

OBJECTIVE To explore the value of alpha-fetoprotein(AFP),alpha-fetoprotein-L3%(AFP-L3%)and des-gamma-carboxy-prothrombin(DCP)in the diagnosis of hepatocellular carcinoma.METHODS The serum levels of AFP,AFP-L3%and DCP in 126 patients with hepatocellular carcinoma and 307 patients with common liver disease(158 cases of liver cirrhosis and 149 cases of chronic hepatitis B)were detected and compared by automatic chemiluminescence immunoassay.RESULTS The serum levels of AFP,AFP-L3%and DCP increased gradually in the chronic hepatitis B group,the liver cirrhosis group and the hepatocellular carcinoma group,and the differences between the chronic hepatitis B group,liver cirrhosis group and hepatocellular carcinoma group were statistically significant(P<0.01).The serum levels of AFP-L3%and DCP in hepatocellular carcinoma patients increased gradually in the groups of AFP<7μg/L,7μg/L≤AFP<200μg/L and AFP≥200μg/L,and the difference between the two groups was statistically significant(P<0.01).There was no significant difference in the serum levels of DCP and AFP-L3%between the liver cirrhosis group and the chronic hepatitis B group(P>0.05).The sensitivity of DCP in the diagnosis of hepatocellular carcinoma was superior to that of AFP and AFP-L3%.The specificity of AFP-L3%in the diagnosis of hepatocellular carcinoma was superior to that of AFP and DCP.The sensitivity of the three combined diagnosis was better than that of the single serological indicator diagnosis.CONCLUSION AFP-L3%,DCP and AFP have complementary effects in the diagnosis of hepatocellular carcinoma.Combined detection can improve the diagnosis rate of hepatocellular carcinoma.