血清PIVKA-Ⅱ、AFP与HBV-DNA联合检测对HBV所致肝癌的诊断及预后预测价值

The Value of Combined Detection of Serum PIVKA-Ⅱ,AFP and HBV-DNA in the Diagnosis and Prognosis Prediction of HBV-induced Liver Cancer

目的探究血清异常凝血酶原Ⅱ(PIVKA-Ⅱ)、甲胎蛋白(AFP)与乙肝病毒脱氧核糖核酸(HBV-DNA)联合检测对HBV所致肝癌(HCC)的诊断及预后预测价值。方法选取2018年8月至2020年7月在本院接受治疗的98例HCC患者作为研究对象(肝癌组),另取同期95例体检健康人群作为健康组,95例肝硬化患者作为肝硬化组,观察3组受试者血清PIVKA-Ⅱ、AFP与HBV-DNA表达水平和一般资料差异。根据肝癌组3年内预后情况将患者分为生存组(57例)和死亡组(41例)。比较肝癌组一般资料和血清PIVKA-Ⅱ、AFP与HBV-DNA水平关系;多因素Logistic和COX回归分析分别分析影响受试者患肝癌和患者预后不良的影响因素;四格表法计算血清PIVKA-Ⅱ、AFP与HBV-DNA水平对HCC的预测价值;ROC曲线分析评估血清PIVKA-Ⅱ、AFP与HBV-DNA水平对HCC患者预后的预测价值。结果肝癌组患者血清PIVKA-Ⅱ、AFP与HBV-DNA水平显著高于健康组和肝硬化组(P<0.05);HCC发病与血清PIVKA-Ⅱ、AFP与HBV-DNA水平有关,且是危险因素(P<0.05)。HCC患者预后不良与血清PIVKA-Ⅱ、AFP与HBV-DNA水平以及肿瘤数量有关(P<0.05),且是危险因素。血清PIVKA-Ⅱ、AFP与HBV-DNA水平以及3项联合诊断HCC发病的准确度分别为77.43%、72.57%、77.43%和84.72%。血清PIVKA-Ⅱ、AFP与HBV-DNA水平以及3项联合诊断HCC预后不良的AUC分别为0.823、0.841、0.824和0.958,3项联合诊断效能优于单一诊断(P<0.05)。结论血清PIVKA-Ⅱ、AFP与HBV-DNA水平在HCC患者和预后不良患者中呈高表达,且3项联合可有效预测HCC发病和HCC患者预后情况。

Objective To explore the value of combined detection of serum protein induced by vitamin K absence or antagonist Ⅱ(PIVKA-Ⅱ),alpha-fetoprotein(AFP)and hepatitis B virus DNA(HBV DNA)in the diagnosis and prognosis of hepatocellular carcinoma(HCC)caused by HBV.Methods From August,2018 to July,2020,98 HCC patients who received treatment in our hospital were regarded as the study subjects(liver cancer group),while 95 healthy individuals who underwent physical examinations were enrolled as the healthy group,and 95 patients with liver cirrhosis were selected as the liver cirrhosis group.Serum PIVKA-Ⅱ,AFP,and HBV-DNA expression levels and general patient data among the three groups were collected and compaared.According to the 3-year prognosis of the liver cancer group,patients were separated into a survival group(57 cases)and a death group(41 cases).The general information and the relationship between serum PIVKA-Ⅱ,AFP,and HBV-DNA levels of the liver cancer group were compared and evaluated;Multivariate logistic and COX regression analyses were applied to identify potential influencing factors of liver cancer and poor prognosis,respectively;Four grid table method was applied to calculate the predictive value of serum PIVKA-Ⅱ,AFP,and HBV-DNA levels for HCC;ROC curve was drawn to evaluate the predictive value of serum PIVKA-Ⅱ,AFP,and HBV-DNA levels for the prognosis of HCC patients.Results Serum PIVKA-Ⅱ,AFP,and HBV-DNA levels in the liver cancer group were significantly higher than those in the healthy group and liver cirrhosis group(P<0.05);The incidence of HCC was related to serum PIVKA-Ⅱ,AFP,and HBV-DNA levels,and was a risk factor(P<0.05).The poor prognosis of HCC patients was related to serum PIVKA-Ⅱ,AFP and HBV-DNA levels,and the number of tumors(P<0.05),and was identified as a risk factor.The accuracy of serum PIVKA-Ⅱ,AFP,HBV-DNA levels,and their combination in diagnosing HCC were 77.43%,72.57%,77.43%,and 84.72%,respectively.The efficacy of the three combined diagnoses was better than that of the single-marker diagnosis(P<0.05).AUC values of serum PIVKA-Ⅱ,AFP,HBV-DNA levels,and their combination in diagnosing poor prognosis of HCC were 0.823,0.841,0.824,and 0.958,respectively.The efficacy of the three-marker combined diagnosis was superior to that of the single-marker diagnosis(P<0.05).Conclusion Serum PIVKA-Ⅱ,AFP,and HBV-DNA are highly expressed in HCC patients and patients with poor prognosis,and their combination can effectively predict the onset and prognosis of HCC.