血清DCP、AFP、AFP-L3和HSP90α在原发性肝细胞癌诊断中的应用价值

Application Value of Serum DCP, AFP, AFP-L3 and HSP90α in the Diagnosis of Primary Hepatocellular Carcinoma

目的:探讨血清异常凝血酶原(DCP)、甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、热休克蛋白90α(HSP90α)检测在原发性肝细胞癌(HCC)诊断中的临床应用价值,为临床提供参考。方法:选取2021年10月—2022年6月安徽医科大学附属巢湖医院收治的64例原发性肝癌(PHC)患者作为研究对象,将其中50例HCC患者与同期就诊的30例失代偿期肝硬化患者、30例乙型病毒性肝炎患者及30例健康人群分为HCC组、肝硬化组、肝炎组及健康对照组,检测并比较分析所有研究对象血清DCP、AFP、AFP-L3、HSP90α水平。结果:HCC组血清AFP、AFP-L3、DCP、HSP90α水平及GALAD评分均较其他三组高,差异有统计学意义(H=39.885、28.618、57.601、46.252、85.734,P<0.05)。绘制ROC曲线,AFP、AFP-L3、DCP、HSP90α及GALAD评分的受试者工作特征曲线下面积(AUC)分别为0.804、0.680、0.883、0.838及0.936。GALAD评分联合HSP90α诊断的AUC最高,为0.940。AFP、DCP与HSP90α三者联合可将诊断敏感度提高至84.0%。HBV组AFP、DCP水平及GALAD评分均高于非HBV组,差异有统计学意义(Z=-2.251、-1.668、-2.288,P<0.05),两组AUC值最高者均为GALAD,分别为0.951、0.903。结论:HCC相关肿瘤标志物单项检测敏感性较低,联合检测可明显提高诊断敏感性和准确性,增加HCC筛查阳性率。

Objective:To investigate the clinical application value of serum abnormal prothrombin(DCP),alpha-fetoprotein(AFP),alpha-fetoprotein isoplast(AFP-L3)and heat shock protein 90α(HSP90α)in the diagnosis of primary hepatocellular carcinoma(HCC).Methods:64 patients with primary hepatocelluar carcinoma admitted to Chaohu Affiliated Hospital of Anhui Medical Wiversity were selected.50 HCC patients,30 decompensated cirrhosis patients,30 viral hepatitis B patients and 30 healthy people were divided into HCCgroup,liver cirrhosis group,hepatits group and healthy group.Serum DCP,AFP,AFP-L3 and 90αlevels were compared and analyzed.Results:Serum levels of AFP,AFP-L3,DCP,HSP90αand GALAD score in HCC group were higher than those in other three groups,and the difference was statistically significant(H=39.885,28.618,57.601,46.252,85.734;P<0.05).The area under receiver operating characteristic curve(AUC)of AFP,AFP-L3,DCP,HSP90αand GALAD scores were 0.804,0.680,0.883,0.838 and 0.936,respectively.The AUC of GALAD score combined with HSP90αdiagnosis was the highest(0.940),and the sensitivity was 84.0%.The levels of AFP,DCP and GALAD in HBV group were higher than those in non-HBV group,and the difference was statistically significant(Z=-2.251,-1.668,-2.288;P<0.05).The highest values of AUC in both groups were GALAD(0.951 and 0.903).Conclusion:The sensitivity of single detection of HCC related tumor markers is low.Combined detection can significantly improve the diagnostic sensitivity and accuracy,and increase the positive rate of HCC screening.