AFP、AFP-L3和PIVKA-Ⅱ联合检测在肝细胞肝癌诊断中的应用价值

The value of combined detection of AFP,AFP-L3 and PIVKA-Ⅱin the diagnosis of hepatocellular carcinoma

目的探究甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和异常凝血酶原(PIVKA-Ⅱ)联合检测在肝细胞肝癌(HCC)早期诊断及监测的应用价值。方法回顾性分析2018年1月至2023年1月安徽医科大学附属滁州医院肝胆胰脾外科一病区137例HCC患者的临床资料,另将同期收治71例非HCC的肝脏占位性病变患者作为对照组。采用受试者工作特征(ROC)曲线分析AFP、AFP-L3和PIVKA-Ⅱ联合检测的诊断效能,并分析三种肿瘤标志物与HCC临床特征间的关系。结果HCC组的AFP、AFP-L3和PIVKA-Ⅱ水平均高于对照组,差异具有统计学意义(P<0.05)。肿瘤直径≥5cm时,,AFP-L3和PIVKA-Ⅱ的表达水平高于肿瘤直径<5cm组,差异具有统计学意义(P<0.05)。HCC患者合并门静脉癌栓和BCLC分期较晚者AFP、AFP-L3和PIVKA-Ⅱ的表达水平更高,差异具有统计学意义(P<0.05)。绘制AFP、AFP-L3、PIVKA-Ⅱ以及联合检测诊断HCC的受试者工作特征(ROC)曲线,计算曲线下面积(AUC)。单独检测时,PIVKA-Ⅱ的AUC值最高,为0.862(95%CI:0.809~0.914),敏感度为0.847,特异度为0.789;AFP-L3的特异度最高(0.944),敏感度最低(0.599)。AFP、AFP-L3和PIV-KA-Ⅱ三者联合检测AUC值升至0.870(95%CI:0.818~0.922),敏感度和特异度分别为0.883和0.789。结论AFP、AFP-L3和PIVKA-Ⅱ联合检测可提高对HCC的早期检出率,三种肿瘤标志物的表达水平可反映HCC进展和肿瘤的生物学特性,有助于预测和评估肿瘤的侵袭性和患者的预后。

Objective To explore the application value of combined detection of alpha-fetoprotein(AFP),alpha-fetoprotein-L3(AFP-L3)and prothrombin induced by vitamin K absenceⅡ(PIVKA-Ⅱ)in the early diagnosis and monitoring of hepatocellular carcinoma(HCC).Methods The clinical data of 137 patients with HCC in the First Ward of Hepatobiliary Pancreatic and Splenic Surgery of Chuzhou Hospital affiliated to Anhui Medical University from January 2018 to January 2023 were retrospectively analyzed.In addition,71 patients with non-HCC lesions treated in the same period were collected as the control group.The diagnostic efficacy of AFP,AFP-L3 and PIVKA-Ⅱcombined detection was analyzed using the subject working characteristic(ROC)curve,and the rela-tionship between the three tumor markers and the clinical characteristics of HCC was analyzed.Results AFP,AFP-L3 and PIVKA-Ⅱin the control group were significantly higher than those in the control group(P<0.05).When the diameter of the tumor was≥5cm,the expression levels of AFP-L3 and PIVKA-Ⅱwere higher than those of the group with a diameter of<5cm,and the difference was statistically significant(P<0.05).HCC patients with portal vein tumor thrombus and those with late BCLC staging,had higher levels of AFP,AFP-L3,and PIVKA-Ⅱexpression,with statistically significant differences(P<0.05).Draw subject operating characteris-tic(ROC)curves for AFP,AFP-L3,PIVKA-Ⅱ,and joint detection and diagnosis of HCC,and calculate the area under the curve(AUC).When tested separately,PIVKA-Ⅱhas the highest AUC value,0.862(95%CI:0.809~0.914),sensitivity 0.847 and speci-ficity 0.789;AFP-L3 has the highest specificity(0.944)and the lowest sensitivity(0.599).The combined detection of AFP,AFP-L3 and PIVKA-Ⅱincreased the AUC value to 0.870(95%CI:0.818~0.922),and the sensitivity and specificity were 0.883 and 0.789,respectively.Conclusion The combined detection of AFP,AFP-L3 and PIVKA-Ⅱcan improve the early detection rate of HCC.The expression of three tumor markers can reflect the progress of HCC and the biological characteristics of tumor,which can help predict and evaluate the invasion of tumor and the prognosis of patients.