血清PIVKA-Ⅱ对原发性肝癌的临床诊断价值

Clinical Diagnostic Value of Serum PIVKA-Ⅱin Primary Hepatocellular Carcinoma

目的探讨血清异常凝血酶原(protein induced by vitamin K absence or antagonist-Ⅱ,PIVKA-Ⅱ)和甲胎蛋白(AFP)对原发性肝癌(primary hepatocellular carcinoma,PHC)的临床诊断价值.方法选取PHC患者98例,肝硬化患者50例,慢性肝炎患者50例,健康体检者50名;检测其血清PIVKA-Ⅱ、AFP水平,绘制受试者工作特征曲线(Receiver operating characteristic curve,ROC),并计算临界值、灵敏度、特异度及曲线下面积(Area under the curve,AUC);诊断PHC的临界值:血清PIVKA-Ⅱ为40 mAu/mL,AFP为20 ng/mL.结果PHC组血清PIVKA-Ⅱ、AFP水平高于其他3组(P<0.05);血清PIVKA-Ⅱ、AFP及联合诊断PHC的AUC面积分别为0.931、0.887和0.934,灵敏度分别为89.80%、84.70%、91.80%,特异度分别为88.70%、87.30%、84.00%;将40 mAu/mL、20 ng/mL分别作为血清PIVKA-Ⅱ、AFP诊断PHC临界值时,联合诊断优于二者单独诊断;血清PIVKA-Ⅱ对血清AFP阴性、血清AFP阳性的PHC患者均有诊断价值(P>0.05).结论血清PIVKA-Ⅱ可用于PHC的诊断,尤其对于AFP阴性PHC的诊断;血清PIVKA-Ⅱ、AFP联合诊断PHC的价值优于二者的单独诊断.

Objective To investigate the clinical diagnostic value of protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in primary hepatocellular carcinoma(PHC).Method 98 patients with PHC,50 patients with cirrhosis,50 patients with chronic hepatitis,and 50 patients undergoing physical examination were selected.Detect serum levels of PIVKA-Ⅱand AFP.Results The level of serum PIVKA-Ⅱand AFP in the PHC group was higher than other three groups(P<0.05).The AUC areas of serum PIVKA-Ⅱ,AFP and their combination in the diagnosis of PHC were 0.931,0.887 and 0.934,respectively,the sensitivity was 89.80%,84.70%and 91.80%,and the specificity was 88.70%,87.30%and 84.00%,respectively.When 40 mAu/mL and 20 ng/mL were used as the critical values of serum PIVKA-Ⅱand AFP for the diagnosis of PHC,resp-ectively,the combined diagnosis was better than the two alone.Serum PIVKA-Ⅱhas diagnostic value for both serum AFP-negative and serum AFP-positive PHC diagnostic value(P>0.05).Conclusion Serum PIVKA-Ⅱcan be used for the diagnosis of PHC,especially for the diagnosis of AFP-negative PHC.The combined value of serum PIVKA-Ⅱand AFP in the diagnosis of PHC is better than the diagnosis of single detection.The serum PIVKA-Ⅱfor AFP-negative PHC has diagnostic value.