AFP联合血脂指标在慢性乙型肝炎相关肝细胞癌诊断中的价值

The value of lipid indicators combined with AFP in the diagnosis of chronic hepatitis B⁃related hepatocellular carcinoma

目的探讨甲胎蛋白(AFP)联合血脂指标在慢性乙型肝炎相关肝细胞癌中的诊断价值,为临床提供参考。方法选取2012年1月-2018年9月中山大学附属第三医院收治的乙型肝炎病毒(HBV)感染患者1045例,其中HBV非肝癌组患者724例,HBV相关肝细胞癌组患者321例。单因素分析和多因素logistic回归分析筛选变量,构建慢性乙型肝炎相关肝细胞癌的logistic回归模型,采用受试者工作特征(ROC)曲线下面积评估该模型的诊断效能。结果HBV相关肝细胞癌组患者的性别、AFP、年龄、甘油三酯、低密度脂蛋白胆固醇与HBV非肝癌组患者相比,差异均有统计学意义(χ^(2)/Z=16.651、253.415、-11.183、-3.309、-4.155,P均<0.05)。多因素logistic回归分析发现,男性、年龄、AFP(20~<400)ng/mL、AFP(400~)ng/mL及低密度脂蛋白胆固醇是HBV相关肝细胞癌的独立危险因素(OR=4.886、1.081、4.101、34.604、1.518,P均<0.001),甘油三酯是其保护因素(OR=0.413,P<0.001),由以上指标构建的logistic回归模型与独立AFP的ROC曲线下面积分别为0.870(敏感度:0.773,特异度:0.815)和0.748(敏感度:0.698,特异度:0.713)。结论血清AFP联合甘油三酯、低密度脂蛋白胆固醇的logistic回归模型诊断效能良好,对慢乙肝相关肝细胞癌的早期诊断具有一定的临床意义。

Objective To investigate the diagnostic value of serum alpha⁃fetoprotein(AFP)combined with lipid indicators in chronic hepatitis B⁃related hepatocellular carcinoma(HCC).Methods A total of 1045 patients with hepatitis B virus(HBV)infection admitted to the Third Affiliated Hospital of Sun Yat⁃sen University from January 2012 to September 2018 were selected,including 724 patients with HBV non⁃HCC and 321 patients with HBV⁃related HCC.Univariate analysis and multivariate logistic regression analysis were used to screen variables to construct a logistic regression model for chronic hepatitis B⁃related HCC.The area under the receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of the model.Results There were statistically significant differences in sex,AFP,age,triglyceride and low⁃density lipoprotein cholesterol between the HBV⁃related HCC group and the HBV non⁃HCC group(χ^(2)/Z=16.651,253.415,-11.183,-3.309,-4.155;all P<0.05).Multivariate logistic regression analysis showed that male,age,AFP 20-<400 ng/mL,AFP 400-ng/mL,and low⁃density lipoprotein cholesterol were independent risk factors for HBV⁃related HCC(OR=4.886,1.081,4.101,34.604,1.518;all P<0.001),while triglyceride was a protective factor(OR=0.413,P<0.001).The area under the ROC curve of the logistic regression model constructed by the above indicators and independent AFP was 0.870(sensitivity:0.773,specificity:0.815)and 0.748(sensitivity:0.698,specificity:0.713),respectively.Conclusion The logistic regression model of serum AFP combined with triglyceride and low⁃density lipoprotein cholesterol had a good diagnostic efficiency,which had certain clinical significance for the early diagnosis of hepatitis B⁃related HCC.