异常凝血酶原(PIVKA-Ⅱ)检测在肝细胞癌中的临床价值  

Clinical value of the abnormal prothrombin PVKIA-Ⅱ in detection of hepatocellular carcinoma

作　　者：林莺莺[1] 陈燕[1] 陈岩松[1] 胡敏华[1] 周旭升[1] 罗玲清[1] 

机构地区：[1]福建医科大学教学医院福建省肿瘤医院检验科,福州350014

出　　处：《现代免疫学》2015年第4期328-333,327,共7页Current Immunology

基　　金：国家临床重点专科建设项目

摘　　要：分别在全自动免疫分析仪(化学发光法)和全自动电化学发光免疫分析仪(电化学发光法)上测定手术前的100例肝细胞癌患者、68例肝硬化和22例慢性乙肝患者以及100例健康体检者的PVKIA-Ⅱ和AFP的血清水平,探讨其与AFP单项及联合检测在肝细胞癌的诊断价值。结果显示肝细胞癌患者PVKIA-Ⅱ和AFP的血清水平分别与肝硬化、慢性乙肝患者和正常对照组比较,差异均有统计学意义(P<0.01)。以试剂盒参考值为诊断点时,PVKIA-Ⅱ在肝细胞癌的敏感性和特异性分别为94%和88.9%,均高于AFP(76%和88.4%)。PVKIA-Ⅱ的敏感性与肝癌患者的临床分期显著相关,随着分期的升高而升高。在Ⅰ期的肝细胞癌患者中,PVKIA-Ⅱ和AFP的敏感性均为66.7%,而二者联合检测的敏感性达到88.9%。PVKIA-Ⅱ和AFP单项和联合检测的ROC曲线下面积分别为0.948、0.906和0.961,以约登指数为诊断点时,PVKIA-Ⅱ检测的敏感性和特异性分别为96.0%和88.9%,高于AFP(86.0%和83.7%)。以单变量统计分析治疗前PVKIA-Ⅱ在不同临床特征的肝细胞癌中的表达。结果表明PVKIA-Ⅱ表达敏感性在不同肿块大小和数量的肝癌患者中差异有统计学意义(P<0.05),而在不同年龄、性别、发现肝癌途径、表面抗原状态、合并肝硬化情况、门脉瘤栓及转移情况以及AFP水平的患者中的表达敏感性差异无统计学意义。AFP阴性肝癌患者PVKIA-Ⅱ敏感性达92%。因此,化学发光法检测PVKIA-Ⅱ在肝细胞癌的筛查、早期诊断、预后判断方面具有良好的临床运用价值,其与AFP联合检测可提高肝细胞癌的早期诊断效率。The serum levels of the abnormal prothrombin PVKIA-Ⅱ and AFP in 100 cases of hepatocellular carcinoma（HCC） before surgery, 90 patients with benign liver diseases and 100 healthy volunteers were examined by automated immunoassay an- alyzer （chemiluminescent enzyme immunoassay） and automatic electrochemiluminescence immunoassayanalyzer （ECLIA） . The results showed that there were significant differences in the serum levels of PVKIA-Ⅱ and AFP between patients with HCC and those with benign liver diseases and normal controls, and the difference was statistically significant （P 〈0.01）. Sensitivity and specificity of PVKIA-Ⅱ were 94% and 88.9% respectively in HCC, both higher than those of AFP （76% and 88.4%）, and sensitivity of PVKIA-Ⅱ increased with stages of HCC. The sensitivity of PVKIA-Ⅱ and AFP in stage Ⅰ HCC was 66.7% respectively, while the sensitivity of a joint detection increased to 88.9%. The AUC^ROC of individual detection of PVKIA-Ⅱ and AFP and joint detection of PVKIA- Ⅱ and AFP were 0. 948, 0. 906 and 0. 961. When the Youden index was taking as diagnostic points, the sensitivity and specificity of PVKIA-Ⅱ were 96% and 88.9% respectively in HCC, higher than those of AFP （86% and 83.7%）. The expression of PVKIA-Ⅱ varied with tumor mass and number in HCC patients, but irrelevant to age gender of the patients and the way cancer was found, surface antigen status, coexistence of liver cirrhosis , portal vein tumor thrombus, metastasis and AFP levels. The sensitivity of PVKIA-Ⅱ was 92% in AFP-negative HCC patients. Therefore, PVKIA-Ⅱ detected by chemiluminescence had good value in screening, early diagnosis and prognosis of HCC, and its joint detection with AFP could greatly improve the efficiency of early diagnosis of HCC.

关 键 词：异常凝血酶原 甲胎蛋白 肝细胞癌 诊断 联合检测 

分 类 号：R735.7[医药卫生—肿瘤]