血清学指标在肝硬化合并原发性肝癌诊断中的价值  

Value of serum markers in diagnosis of primary hepatic cellular carcinoma in patients with hepatic cirrhosis

作　　者：许杰[1] 王进广[1] 王利明[1] 

机构地区：[1]安徽省蚌埠市第一人民医院消化内科,233000

出　　处：《淮海医药》2015年第2期113-115,共3页Journal of Huaihai Medicine

摘　　要：目的探讨肝硬化患者血清学指标在肝硬化并发原发性肝癌诊断中的价值。方法收集2012年1月-2013年12月入住我院消化内科的肝硬化患者89例,其中肝硬化并发原发性肝癌(PHCC)23例,单纯性肝硬化(HC)66例。根据纳入与排除标准,最终选择55例患者作为研究对象(PHCC组14例,HC组41例)。所有患者均行血常规、肝功能、电解质、凝血指标、甲胎蛋白及肝炎标志物检查。结果 2组患者流行病学资料未见明显差异,PHCC组患者血清AFP水平显著地高于HC组患者(737.89±197.21 vs 54.29±10.08,P=0.003),与HC组患者相比,PHCC组患者AST/ALT比值(1.76±1.05 vs 1.25±0.49,P=0.018)和GGT/ALT比值(6.70±10.92 vs 2.84±3.29,P=0.047)均显著增高。在肝硬化并发原发性肝癌的诊断中,AST/ALT的敏感性为64.3%,特异性73.2%(cutoff值1.43);GGT/ALT敏感性为42.9%,特异性为85.4%(cutoff值3.72)。结论肝硬化并发原发性肝癌患者血清AFP水平显著升高,联合AST/ALT比值、GGT/ALT比值检测能够提高肝硬化患者并发原发性肝癌的检出率。Objective To evaluate the role of serum markers in diagnosis of primary hepatic cellular carcinoma（ PHCC）in patients with hepatic cirrhosis（ HC）. Methods A total of 89 cirrhotic patients hospitalized in our hospital were enrolled（ 23 PHCC patients and 66 HC patients）. According to the including and excluding criterion,55 of them were finally selected for the study（ PHCC group 14,HC group 41）. Each subject accepted a series of serum tests including blood cell count,hepatic function,electrolyte,prothrombin function,alpha fetoprotein（ AFP） and hepatic virus markers. Results No significant differences were found as to the basic epidemiologic conditions between the two groups. The level of serum AFP in the PHCC group was higher than that in the HC group（ 737. 89 ± 197. 21 vs 54. 29 ± 10. 08,P = 0. 003）. Compared with HC group,both the AST / ALT ratio（ 1. 76 ± 1. 05 vs 1. 25 ± 0. 49,P = 0. 018） and GGT / ALT ratio（ 6. 70 ± 10. 92 vs 2. 84 ± 3. 29,P = 0. 047）increased significantly. In terms of the diagnosis of PHCC in cirrhotic patients,the sensitivity and specificity rates of AST / ALT were 64. 3% and 73. 2%（ cutoff value was 1. 43）,while the correspondent rates of GGT / ALT were 42. 9% and 85. 4%（ cutoff value was 3. 72）,respectively. Conclusion Serum level of AFP in cirrhotic patients with PHCC increases significantly. A combined assessment of the ratios of AST / ALT and GGT / ALT could be of much help in detecting PHCC in cirrhotic patients.

关 键 词：肝硬化 原发性肝细胞肝癌 甲胎蛋白 AST/ALT GGT/ALT 

分 类 号：R575.2[医药卫生—消化系统]