甲胎蛋白、AFP-L3%和DCP在HBV相关肝细胞癌早期诊断中的临床价值

Clinical value of alpha-fetoprotein:alpha-fetoprotein-L3 isoform ratio and des-γ-carboxyprothrombin in early diagnosis of HBV-related hepatocellular carcinoma

目的探讨甲胎蛋白、甲胎蛋白异质体3比率(AFP-L3%)和脱-γ-羧基凝血酶原(DCP)不同组合用于HBV相关肝细胞癌患者的早期诊断。方法纳入167例受试者,其中肝细胞癌组100例,HBV感染相关肝硬化组(肝硬化组)67例,通过化学发光酶免疫法检测血清甲胎蛋白、AFP-L3%和DCP水平,采用受试者操作特征(ROC)曲线进行分析。结果肝细胞癌组甲胎蛋白、AFP-L3%和DCP水平明显高于肝硬化组(P均﹤0.05)。肝细胞癌组0期和A期比较甲胎蛋白和AFP-L3%水平差异均无统计学意义(P均﹥0.05);肝细胞癌组0期DCP水平明显低于肝细胞癌组A期(P﹤0.05)。甲胎蛋白、AFP-L3%和DCP诊断早期肝细胞癌的灵敏度和特异度分别为51.5%、92.5%、28.3%和95.5%、60.0%、84.7%。ROC曲线下面积(AUC)结果分析显示甲胎蛋白、AFP-L3%和DCP诊断早期肝细胞癌的AUC值分别为0.760、0.619和0.749;甲胎蛋白和DCP联合检测的AUC值为0.810,具有最高诊断效能。结论甲胎蛋白诊断早期肝细胞癌具有重要诊断价值,甲胎蛋白和DCP联合可提高HBV相关早期肝细胞癌的诊断效能。

Objective To evaluate the value of different combinations of alpha-fetoprotein(AFP),alpha-fetoprotein-L3 isoform ratio(AFP-L3%)and des-γ-carboxyprothrombin(DCP)for early diagnosis of hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC).Methods A total of 167 patients were enrolled in this study,including 100 patients with HCC and 67 patients with infection-related liver cirrhosis(LC).The levels of serum AFP,AFP-L3%and DCP were detected by chemiluminescence enzyme immunoassay.The receiver operating characteristic(ROC)curve was delineated for subsequent analysis.Results The levels of AFP,AFP-L3%and DCP in HCC patients were significantly higher than those in LC patients(all P<0.05).There was no significant difference in AFP and AFP-L3%levels between stage 0 and stage A patients in HCC group(both P>0.05).DCP levels in stage 0 patients were significantly lower than those in stage A patients in HCC group(P<0.05).The sensitivity and specificity of AFP,AFP-L3%and DCP in the diagnosis of early HCC were 51.5%,92.5%,28.3%,and 95.5%,60.0%,84.7%,respectively.Analysis of the area under the ROC curve(AUC)results showed that the AUC values of AFP,AFP-L3%and DCP for the diagnosis of early HCC were 0.760,0.619 and 0.749,respectively.The AUC value of combined detection of AFP and DCP was 0.810,which yielded the highest diagnostic efficiency.Conclusion AFP has important diagnostic value in the diagnosis of early HCC.The combination of AFP and DCP can improve the diagnostic efficiency of HBV-related early HCC.