血清甲胎蛋白对原发性肝细胞癌诊断价值的再评价  

Re-evaluation of the diagnostic value of serum AFP for patients with primary hepatocellular carcinoma

作　　者：李鹏[1] 刘珲[2] 孙琳[2] 范春蕾[1] 李磊[1] 董培玲[1] 张斌[1] 李宁[1] 丁惠国[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝病消化科,100069 [2]首都医科大学附属北京佑安医院病理中心,100069

出　　处：《北京医学》2010年第9期712-715,共4页Beijing Medical Journal

基　　金：中国科学院病原微生物与免疫学重点实验室开放基金(2009CASPMI-004);国家十一五重大专项(2008ZX10002-015)

摘　　要：目的评价血清甲胎蛋白(alpha-fetoprotein,AFP)对原发性肝细胞癌(hepatocellular carcinoma,HCC)的诊断价值。方法以病理确诊的HCC185例及肝炎肝硬化125例为研究对象,AFP测定采用微粒子酶联免疫法。将AFP测定值连续划分为9个数据段,计算敏感度、特异度、阳性似然比、阴性似然比、诊断优势比及准确度。应用SPSS16.0统计软件绘制受试者工作曲线(ROC),确定最适合临界值。Kaplan-Meier生存曲线分析不同AFP水平患者的生存率。结果 AFP Cut-off值为20μg/L时敏感度最高,为54.6%;400μg/L时特异度最高,为97.6%;250μg/L时,阳性似然比、特异度及诊断优势比均为最高,分别为12.838、97.6%及18.109,ROC曲线下面积最大,为0.722。AFP水平与年龄、性别、ALT水平、Child分级及HBeAg阳性与否无关。AFP<20μg/L的HCC患者2年生存率高于AFP≥20μg/L的患者(P<0.05),对于AFP<20μg/L的患者,手术治疗1年生存率高于非手术治疗(P<0.05)。结论对于HCC的诊断,AFP为250μg/L时效能最高。AFP水平与HCC患者预后有关。Objective To re-evaluate the diagnostic value of sera AFP for primary hepatocellular carcinoma（HCC）.Methods 185 patients with HCC histopathologically confirmed and 125 patients with cirrhosis were included.Sera AFP was detected with microparticle enzyme-linked immunosorbent assay.Cut-off values of AFP were divided into 9 sequent levels.The sensitivity,specificity,positive and negative likelihood ratio（LR＋,LR-）,diagnostic odd ratio（dOR） and accuracy were calculated with 2×2 table.Receiver operator characteristic curve（ROC） was presented with SPSS16.0 software.The diagnostic value of AFP for HCC was determined with above evaluation indexes.Kaplan-Meier survival curve analysis of survival in patients with different levels of AFP was made.Results The sensitivity was 54.6% for diagnosis of HCC as cut-off value of AFP was 20μg/L,was the highest one in all of the cutoff value.and the specificity was 97.6% as AFP was 400μg/L,was the highest one in all of the cutoff value.The LR＋,specificity and dOR was the highest as AFP was 250μg/L,the LR＋,specificity and dOR were 12.838,97.6% and 18.109.It had the largest area under the ROC curve,which was 0.722.The best diagnostic value of AFP for HCC was 250μg/L.No correlation was observed between the level of serum AFP and clinical information of the patient,including sex,gender,level of ALT,Child degree of hepatic function and whether HBeAg positive or not.The 2-years survival rate in HCC patients with AFP20μg/L was higher than the patients with AFP≥20μg/L（P0.05）.For the patients with AFP 20μg/L,1-year survival rate of surgical treatment was higher than that of non-surgical treatment（P0.05）.Conclusions It is suggested that 250μg/L of AFP seems a suitable diagnostic cut-off value for HCC.There exists the relationship between serum AFP and survival in HCC patients.

关 键 词：原发性肝癌 甲胎蛋白 CUT-OFF值 生存分析 

分 类 号：R735.7[医药卫生—肿瘤]