血清PIVKA-Ⅱ在肝癌诊断中的应用  

Study on the significance of serum PIVKA- Ⅱ in diagnosis of hepatocellular carcinoma

作　　者：朱宇[1] 王海[2] 王宏洁[1] 王慜杰[1] 韩彬彬[1] 张春[1] 李学祥[1] 杜君[3] 齐军[1] 

机构地区：[1]中国医学科学院肿瘤医院肿瘤研究所检验科,北京100021 [2]吉林大学中日联谊医院检验科,长春吉林130031 [3]中国医学科学院肿瘤医院肿瘤研究所分子肿瘤学国家重点实验室,北京100021

出　　处：《临床和实验医学杂志》2014年第7期513-516,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金青年科学基金资助项目(81101857)

摘　　要：目的检测肝癌患者血清中的人异常凝血酶原即维生素K缺乏或拮抗剂Ⅱ诱导的蛋白（PIVKA—Ⅱ）的浓度，并评价其对肝癌的诊断价值。方法采用PIVKA—Ⅱ和AFP检测试剂盒，分别对136例治疗前的肝癌患者（包括80例早期肝癌和56例中晚期肝癌），56例肝炎患者和136例健康者血清样本进行检测。运用受试者工作特性曲线（ROC）分析PIVKA—Ⅱ和甲胎蛋白（AFP）的检测效能，并确定PIVKA—Ⅱ检测肝癌的临界值。比较PIVKA—Ⅱ和AFP检测肝癌的灵敏度和准确率。结果健康组、慢性肝炎组、早期肝癌组和中晚期肝癌组的血清PIVKA—Ⅱ的中位浓度分别为18．0（15．0～20．0）mAU／ml、18．0（14，0～23．0）mAU／ml、345．0（31．8～3787．0）mAU／ml和1008．5（30．3～25788．0）mAU／ml，早期肝癌组显著高于健康组（P〈0．001）和慢性肝炎组（P〈0．001），低于中晚期肝癌组（P=0．375）。血清PIVKA—Ⅱ检测肝癌的曲线下面积（AUC）为0．936（95％C10．908—0．964），显著优于AFP的检测能力[VS．0．848（95％c10．800～0．896），z值=3．580，P〈0．001]。PIVKA-Ⅱ检测肝癌的最佳临界值为25．5mAU／ml，此时灵敏度为84．6％，特异度为90．6％。联合PIVKA—Ⅱ和AFP检测，可增加肝癌诊断的灵敏度（VS．PIVKA—Ⅱ，P=0．036；vs．AFP，P〈0．001）。结论血清PIVKA—Ⅱ对于肝癌的诊断效能优于AFP，可作为肝癌早期筛查的血清标志物应甩于临床，为肝癌的早诊早治提供帮助。Objective The aim of this study was to determine the significance of serum levels of PIVKA - Ⅱ （ prothrombin induced by vi- tamin K absence or antagonist - Ⅱ ） and AFP （ α - fetoprotein） in diagnosis of HCC （ Hepatocellular carcinoma） in Chinese population. Methods The study group consisted of 136 HCC patients （ including 80 early stage HCC and 56 intermediate - advanced stage HCC patients）, 56 patients with chronic hepatitis and 136 healthy controls. All patients and controls were examined for serum levels of PIVKA - Ⅱ and AFP. Results The mean serum levels of PIVKA - Ⅱ in healthy controls, patients with chronic hepatitis, patients with early stage HCC and patients with intermediate -advanced stage HCC were 18.0 （15.0 -20.0） mAU/ml, 18.0 （14.0 -23.0） mAU/ml, 345.0 （31.8 -3 787.0） mAU/ml and 1 008.5 （30.3 -25 788. 0） mAU/ml, respectively. The mean level of PIVKA - IT in patients with early stage HCC was significantly greater than that of healthy controls （ P 〈0. 001 ） and patients with chronic hepatitis （ P 〈0,001 ）, respectively. PIVKA - Ⅱ had better area under the receiver operating characteristic curve [ 0. 936 （95 % CI 0. 908 - 0. 964） ] than AFP [ vs. 0. 848 （95 % CI 0. 800 - 0. 896）, Z = 3. 580, P 〈 0. 001 ]. The optimal PIVKA - Ⅱ cutoff value was 25.5 mAU/ml leading to a sensitivity of 84.6% and specificity of 90.6%. A combination detection of serum levels of PIVKA - Ⅱ and AFP could increase the sensitivity in diagnosis of HCC （ vs. PIVKA - Ⅱ , P = 0. 036 ; vs. AFP, P 〈 0. 001 ）. Conclu- sion PIVKA - Ⅱ is more sensitive than AFP in diagnosis of HCC, and PIVKA - Ⅱ can serve as a marker for screening HCC.

关 键 词：肝癌 人异常凝血酶原 诊断 

分 类 号：R735.7[医药卫生—肿瘤]