血清GPC3、DCP、GP73及AFP联合检测在原发性肝癌的诊断价值

The Clinical Application of Serum GPC3,DCP,GP73 andAFP in Hepatocellular Carcinoma

目的探讨血清磷脂酰肌醇蛋白聚糖-3(GPC3)、异常凝血酶原(DCP)、高尔基体糖蛋白(GP73)及甲胎蛋白(AFP)联合检测在原发性肝癌(HCC)的临床价值。方法选取2016年4月至2018年11月首都医科大学附属北京同仁医院收治的51例HCC患者,36例肝硬化患者,63例肝纤维化患者,73例慢性活动性肝炎患者及80例表观健康人作对照组。检测各组血清中GPC3、DCP、GP73及AFP的水平。结果HCC组血清GPC3、DCP、GP73及AFP的水平与肝硬化组、肝纤维化组、肝炎组和健康对照组比较,差异均有统计学意义(P<0.05);通过ROC曲线分析将GPC3、DCP、GP73及AFP鉴别诊断肝癌的临界值分别设定为0.093ng/mL、40.38ng/mL、167.90ng/mL、12.53ng/mL,曲线下面积分别为0.723、0.731、0.602、0.812。HCC组血清GPC3、AFP、DCP、GP73阳性检出率分别高于肝硬化组、肝纤维化组、肝炎组和健康对照组,差异均有统计学意义(P均<0.05)。在单项检测中AFP的灵敏度和准确度最高分别为58.8%、72.4%,GPC3和AFP特异性最高均为91.7%。平行实验中GPC3+GP73+AFP灵敏度、特异性和准确度最高分别为86.3%、83.3%、85.1%。结论AFP仍是目前诊断HCC的重要指标,血清GPC3、DCP、GP73及AFP联合应用能够弥补单项检测的不足,对提高HCC的诊断效能具有重要意义。

Objective To explore the clinical application values of Glypican-3(GPC3), Des-γ-carboxy prothrombin(DCP), Golgi Protein 73(GP73) and alpha-fetoprotein(AFP) in hepatocellular carcinoma(HCC).Methods From April, of 2016 to August, of 2017, 50 cases of HCC patients, 36 cases of cirrhotic patients, 63 cases of hepatofibrosis patients, 73 cases of chronic hepatitis patients and 80 cases of healthy people were selected from Beijing Tongren Hospital Affiliated to Capital Medical University. Serum levels of GPC3, DCP, GP73 and AFP were detected in each group.Results Serum levels of GPC3, DCP, GP73 and AFP in the HCC group were significantly different compared with those in the cirrhosis group, the liver fibrosis group, the hepatitis group and the healthy control group(P<0.05). ROC curve analysis identified the critical values of GPC3, DCP, GP73 and AFP for the differential diagnosis of liver cancer as 0.093 ng/mL, 40.38 ng/mL, 167.90 ng/mL and 12.53 ng/mL, respectively. The area under the curve were 0.723, 0.731, 0.602 and 0.812, respectively. The positive detection rates of serum GPC3, AFP, DCP and GP73 in the HCC group were higher than those in the cirrhosis group, liver fibrosis group, hepatitis group and healthy control group, respectively, with statistically significant differences(all P<0.05). In single-index test, the highest sensitivity and accuracy of AFP were 58.8% and 72.4% respectively, and the highest specificity of GPC3 and AFP was 91.7%. In parallel experiments, the highest sensitivity, specificity and accuracy of GPC3+GP73+AFP were 86.3%, 83.3% and 85.1%, respectively.Conclusion AFP remains to be one of the important indicators for the diagnosis of HCC, and the combined application of serum GPC3, DCP, GP73 and AFP can improve the deficiency of single-index detection, which is of great significance to facilitate the diagnostic efficiency of HCC.