血清AFP—IgM复合物对原发性肝癌的诊断意义  

Detection of the diagnosis about primary hepatocellular carcinoma with the AFP-IgM immune complexes in serum

作　　者：蒋敬庭[1] 吴昌平[1] 吴骏[1] 秦锡虎[1] 孙达成 季枚[1] 徐斌[1] 邓海峰[1] 陆明洋[1] 周国平[3] 李敏[1] 郑晓[1] 刘检[1] 石亮荣[1] Ning Xu Peter Nilsson-Ehle 

机构地区：[1]江苏省苏州大学附属第三医院肿瘤生物诊疗中心,常州213003 [2]常州市妇产医院 [3]常州市第三人民医院 [4]瑞典隆德大学医学院

出　　处：《中华检验医学杂志》2008年第7期789-792,共4页Chinese Journal of Laboratory Medicine

基　　金：苏州大学医学发展基金资助项目（EE12407）;常州市卫生局重大招标资助项目（ZD200710）;常州市社会发展计划资助项目（CS2007202）志谢 东南大学公共卫生学院陈启光教授与陈炳为博士在本课题的设计与数据处理过程中提供帮助

摘　　要：目的评价新型肿瘤标志物甲胎蛋白-IgM免疫复合物（AFP-IgM）对原发性肝细胞癌（PHC）的诊断意义。方法用酶联免疫吸附法与电化学发光法分别检测103名健康人、74例原发性肝细胞癌、27例中度肝硬化和63例慢性肝炎患者血清AFP-IgM与甲胎蛋白（AFP）含量。以非肝癌组（健康人、中度肝硬化和慢性肝炎）作为对照组。结果AFP的ROC曲线下面积大于AFP-IgM（0．85vs0．72，Z=3．21），并应用ROC曲线确定AFP-IgM和AFP的临界值分别为3×10^5AU／L和10μg／L。在此临界值下，AFP-IgM和AFP对PHC的敏感度分别为64．9％和79．7％，特异度分别为75．6％和80．3％，两者的有效性相近；但对早期（Ⅰ与Ⅱ期）肝癌诊断时，AFP-IgM的ROC曲线下面积大于AFP（0．91vs0．82，Z=1．73），差异具有统计学意义，其敏感度分别为94．4％和72．2％，特异度分别为81．9％和79．9％；联合检测以两项均为阳性诊断原发性肝癌：特异度可达89．1％，有效性为79．0％。结论采用AFP联合AFP-IgM检测可提高PHC诊断的特异度和有效性，但对于原发性肝癌的早期诊断AFP-IgM的敏感度与特异度均比AFP更高，AFP-IgM对原发性肝癌的早期诊断更具重要意义。Objective To evaluate the significance of AFP-IgM, this is one of new tumor markers, in the diagnosis of primary hepatocellular carcinoma （PHC）. Methods The contents of AFP-IgM and AFP in serum of 103 healthy subjects, 74 patients suffered primary hepatic carcinoma, 27 patients affected by liver cirrhosis and 63 patients affected by chronic hepatitis were detected by means of enzyme linked immunosorbent assay and electrochemiluminescence. No-PHC is comprised of liver cirrhosis, chronic hepatitis and health subjects as control group. Results The area under ROC curve of AFP was larger than that of AFP-IgM （0. 85 vs 0. 72, Z = 3.21 ） and the best cut-off value of AFP-IgM and AFP was 3×10^5 AU/L and 10 μg/L respectively, which was determined by ROC curve. Under the cut-off value, the sensitivity of AFP- IgM and AFP for PHC were 64. 9% and 79. 7%, and the specificity were 75.6% and 80. 3%, yet their efficacies were similar. However, for early diagnosis of liver cancer （ stage Ⅰ and Ⅱ ） , the area under ROC curve of AFP-IgM was larger than that of AFP （0.91 vs 0. 82,Z = 1.73）. The sensitivity of AFP-IgM and AFP were 94.4% and 72. 2% , and the specificity were 81.9% and 79.9%. The differences of AFP-IgM and AFP for early diagnosis of liver cancer were statistically significant. When both of the test results combined AFP-IgM with AFP are positive, it can be diagnosed as liver cancer. The specificity of combined determination of the two forms was 89. 1%, and the efficacy was 79.0% . Conclusions Both of the sensitivity and specificity of the AFP-IgM test were higher than that of the AFP for early diagnosis of liver cancer. We also found that combined determination of the two forms significantly increased the specificity and the positive predictive value for the diagnosis of PHC, thus AFP-IgM was of especially significance for early diagnosis of liver cancer.

关 键 词：癌 肝细胞 肝肿瘤 甲胎蛋白类 免疫球蛋白M 肿瘤标记 生物学 

分 类 号：R686[医药卫生—骨科学]