AFP、PIVKA-Ⅱ、Ferritin联合应用在肝癌诊断及疗效监测中的效能评价

The Evaluation of the Efficacy of Combined Application of AFP,PIVKA-Ⅱ,and Ferritin in the Diagnosis and Efficacy Monitoring of Liver Cancer

目的评价单独及联合应用甲胎蛋白(AFP)、异常凝血酶原(PIVKA-Ⅱ)、铁蛋白(Ferritin)指标在肝癌诊断及预后评估中的效能。方法回顾性分析10个月内在苏州大学附属第二医院核医学科就诊的体检、门诊、住院患者的AFP、PIVKA-Ⅱ、Ferritin检测数值,按照临床诊断信息分为健康体检组(74例)、肝炎肝囊肿组(63例)、肝硬化组(40例)、腺瘤增生组(76例)及肝癌组(788例),比较各指标在各肝相关分组中的表达水平差异。通过Passing-Bablok回归性分析及Kappa分析评价AFP与PIVKA-Ⅱ的应用特性。通过ROC曲线及Kappa分析比较各指标单独及联合应用在诊断肝恶性肿瘤的效能。比较各指标对肝恶性肿瘤预后的评估价值。结果3指标在各分组中的表达差异明显,AFP在健康人群阳性检出率为4.05%,在肝癌组阳性检出率为57.61%;PIVKA-Ⅱ在健康体检组阳性检出率为4.05%,在肝癌组阳性检出率为64.47%;Ferritin在健康体检组阳性检出率为12.16%,在肝癌组阳性检出率为34.90%。分析AFP与PIVKA-Ⅱ指标相关性,Y=0.0786 X+1.5675,线性度偏差显著;一致性分析,Kappa值为0.381,一致性一般。多指标联合应用在肝癌组的诊断效能高于单一指标,ROC曲线下面积为0.802,在腺瘤增生+肝癌组中诊断的ROC曲线下面积为0.771;在肝癌诊断中,AFP、Ferritin、PIVKA-Ⅱ3项联检的灵敏度为88.96%,特异性为80.24%,高于单项目检测的灵敏度,在良恶性肿瘤诊断中,3项联检的灵敏度为82.52%,特异性为78.53%。3指标在肝癌治疗前后差异明显,AFP在治疗前后中位数由4.11ng/mL下调至3.2ng/mL,Ferritin在治疗前后中位数由244ng/mL下调至223ng/mL,PIVKA-Ⅱ在治疗前后中位数由161mIU/mL下调至24.78mIU/mL;秩和检验分析治疗前后数值差异,AFP:P<0.0247;Ferritin:P<0.4842;PIVKA-Ⅱ:P<0.0001,AFP、PIVKA-Ⅱ指标变化有更强的临床一致性和预后指导价值。结论3项传统肝癌检测指标在良恶性疾病中表达差异明显,其中两个核心指标AFP与PIVKA-Ⅱ一致性较差,但互补性强,联检可以有效提高阳性检出率。相较于腺瘤增生+肝癌综合诊断,多指标联检对单纯肝癌的诊断效能更高。AFP与PIVKA-Ⅱ的疗效监测价值更高。

Objective To evaluate the efficacy of individual and combined use of alpha fetoprotein(AFP),abnormal prothrombin Ⅱ(PIVKA Ⅱ),and ferritin indicators in the diagnosis and prognosis evaluation of liver cancer.Methods A retrospective analysis was conducted on the AFP,PIVKA-Ⅱ,and ferritin detection values from physical examination,outpatient,and inpatient settings in the field of nuclear medicine within 10 months period.According to clinical diagnostic information,patients were divided into the health examination group,hepatitis liver cyst group,cirrhosis group,adenomatous hyperplasia group,and malignant liver cancer group.The expression levels of each indicator in each liver related group were compared.We then evaluated the application characteristics of AFP and PIVKA-Ⅱ through Passing Bablock regression analysis and Kappa analysis.We compared and analyzed the efficacy of various indicators and combined application models in the diagnosis of liver malignant tumors through ROC curves and Kappa.We also compared the evaluation value of various indicators in the prognosis of liver malignant tumors.Results The expression differences of the three indicators in each group were significant.The positive detection rate of AFP in the healthy population was 4.05%,while the positive detection rate in the liver cancer group was 57.61%;The positive detection rate of PIVKA-Ⅱ in the health examination group was 4.05%,while in the liver cancer group it was 64.47%;The positive detection rate of ferritin in the health examination group was 12.16%,while in the liver cancer group it was 34.90%.The correlation between AFP and PIVKA-Ⅱ indicators was:Y=0.0786X+1.5675,with significant linear deviation;Consistency analysis showed a Kappa value of 0.381,indicating moderate consistency.The diagnostic efficiency of the combination of multiple indicators in the liver cancer group was higher than that of a single indicator,with an area under the ROC curve of 0.802.The area under the ROC curve diagnosed in the adenoma hyperplasia+liver cancer group was 0.771;In the diagnosis of liver cancer,the sensitivity of AFP,ferritin,and PIVKA-Ⅱ combined tests was 88.96%,with a specificity of 80.24%,which was higher than the sensitivity of single-item detection.In the diagnosis of benign and malignant tumors,the sensitivity of the three combined tests was 82.52%,with a specificity of 78.53%.The three indicators showed significant differences before and after liver cancer treatment.The median of AFP decreased from 4.11ng/mL to 3.2ng/mL,while ferritin decreased from 244 ng/mL to 223ng/mL,and PIVKA-Ⅱ decreased from 161mIU/mL to 24.78mIU/mL before and after treatment;Rank sum test analysis of numerical differences before and after treatment showed:AFP:P<0.0247;ferritin:P<0.4842;PIVKA-Ⅱ:P<0.0001,and changes in AFP and PIVKA-Ⅱ indicators had stronger clinical consistency and prognostic guidance value.Conclusion There are significant differences in the expression of three traditional liver cancer detection indicators in benign and malignant diseases.Among them,the two core indicators AFP and PIVKA-Ⅱ have a poor consistency,but strong complementarity.Joint testing can effectively improve the positive detection rate.The diagnostic efficacy of multiple indicators combined with adenomatous hyperplasia and malignant liver cancer is higher for simple malignant liver cancer.The efficacy monitoring value of AFP and PIVKA-Ⅱ is even higher.