AFP、AFP-L3%与IGF-1联合检测在原发性肝癌诊断中的价值

The Clinical Value of Combined Detection of AFP,AFP-L3%andIGF-1 in the Diagnosis of Primary Liver Cancer

目的探讨甲胎蛋白(AFP)、甲胎蛋白异质体L3比率(AFP-L3%)与胰岛素样生长因子-1(IGF-1)单独及联合检测在原发性肝癌(PLC)诊断中的价值,并建立原发性肝癌诊断的列线图模型。方法选取2020年12年至2022年3月在南昌大学第一附属医院诊疗的PLC患者143例作为研究组,另选取肝脏良性疾病患者140例,其中肝硬化患者63例,慢性肝炎患者77例,作为良性肝病组;选取体检人员84例,作为对照组。检测各组受试者血清AFP、AFP-L3%和IGF-1水平,对研究组患者AFP、AFP-L3%和IGF-1水平进行Spearman相关性分析;应用受试者工作特征曲线(ROC曲线)下面积评价回归公式的诊断效能,并基于3项指标构建PLC风险列线图预测模型,并采用Bootstrap法进行内部验证。结果研究组患者的AFP和AFP-L3%的表达水平显著高于良性肝病组和对照组(P<0.01),IGF-1的水平显著低于其他两组(P<0.01);3项指标表达均无显著相关性;3项联合检测诊断PLC时,灵敏度和特异性分别为72.73%和83.93%,ROC曲线下面积(AUC)为0.844(95%CI 0.803~0.880),高于单项指标诊断,诊断效能最佳。基于3项指标构建的PLC风险列线图模型的预测结果与实际预测结果的一致性C指数为0.810,显示了良好的预测性能。结论PLC患者血清IGF-1水平显著下调,其与AFP和AFP-L3%联合检测应用于PLC的筛查可相互补充,提高检测的灵敏度和特异性。基于3项诊断指标构建列线图模型可预测PLC的发生风险,对于高风险人群的诊断具有较高的临床应用价值。

Objective To investigate the value of alpha fetoprotein(AFP),alpha fetoprotein heterogeneous L3 ratio(AFP-L3%)and insulin-like growth factor-1(IGF-1)alone or in combination in the diagnosis of primary liver cancer(PLC),and to establish a nomogram model for the diagnosis of primary liver cancer.Methods 143 patients with PLC diagnosed and treated in the First Affiliated Hospital of Nanchang University from December,2020 to March,2022 were selected as the study group,while 140 patients with benign liver disease including 63 patients with liver cirrhosis and 77 patients with chronic hepatitis were selected as the benign liver disease group,and 84 healthy physical examination professionals were selected as the control group.Levels of serum AFP,AFP-L3%and IGF-1 in each group were detected and Spearman correlation analysis was performed on expressions of these three indicators in the study group.The area under the receiver operating characteristic curve(ROC curve)was drawn to evaluate the diagnostic efficacy of the regression formula.PLC risk nomogram prediction model with the three indexes was established,and bootstrap method was used for the internal verification.Results Expression levels of AFP and AFP-L3%in the study group were significantly higher than those in the benign liver disease group and the control group(P<0.01),while the concentration of IGF-1 was significantly lower than those in the other two groups(P<0.01);There was no significant correlation among expressions of three indexes;In the joint diagnosis of PLC,the sensitivity and specificity were 72.73%and 83.93%,respectively,and the area under the ROC curve(AUC)was 0.844(95%CI 0.803-0.880),which was higher than that of each single-index diagnosis,and the diagnostic efficiency was the best.The consistency index between the prediction results of the PLC risk nomogram model based on three indicators and the actual prediction results was 0.810,which showed a good prediction performance.Conclusion The level of serum IGF-1 in patients with primary liver cancer is significantly down-regulated.Its combined application with AFP and AFP-L3%in the screening of PLC can complement each other and improve the sensitivity and specificity of the disease detection.The nomogram model based on three diagnostic indexes can predict the risk of PLC,which has a high clinical application value for the diagnosis of high-risk population.