血清异常凝血酶原水平在胰腺癌诊治中的应用价值  

Clinical application of serum PIVKA-Ⅱ level in the diagnosis and treatment of pancreatic cancer

作　　者：雷旦生[1] 喻晶[1] 

机构地区：[1]湖北省肿瘤医院检验科,武汉430079

出　　处：《中华胰腺病杂志》2016年第4期217-220,共4页Chinese Journal of Pancreatology

摘　　要：目的检测胰腺癌患者血清异常凝血酶原（PIVKA-Ⅱ）水平，探讨其在胰腺癌诊断、疗效评估中的临床应用价值。方法收集湖北省肿瘤医院收治的112例胰腺癌、28例胰腺炎及79例健康者血清，应用化学发光法检测血清PIVKA—Ⅱ水平，同时应用电化学发光法检测血清CEA、CA19-9水平。绘制受试者工作特征（ROC）曲线，确定诊断临界值，计算诊断敏感性、特异性，准确性。结果112例胰腺癌患者的血清PIVKA—II浓度为39．0（22．61，137．67）U／L，显著高于30例胰腺炎患者的23．0（17．32，29．67）U／L及79例健康者的21．21（17．90，25．12）U／L，差异均有统计学意义（P值均〈0．01），而胰腺炎与健康者的差异无统计学意义。血清PIVKA—Ⅱ、CEA、CAl9-9的ROC曲线下面积分别为0．793、0．707、0．849，诊断胰腺癌的临界值分别为32．4、4．7、27．0U／L；敏感性为61．6％、38．0％、66．1％；特异性为86．3％、96．3％、89．9％；准确性为71．7％、62．3％、75．0％。PIVKA一Ⅱ联合CEA、CAl9-9检测的敏感性、特异性、准确性分别为90．2％、76．0％、84．3％。联合检测的敏感性显著提高，特异性略有下降。胰腺癌患者血清PIVKA—Ⅱ水平与肿瘤分期有关。20例追踪监测的患者中15例经手术或介入治疗后血清PIVKA—Ⅱ水平较治疗前显著下降（50．6U／L比110．5U／L，P〈0．001），5例姑息治疗者中4例有不同程度升高。结论检测血清PIVKA-Ⅱ水平对胰腺癌的诊断及疗效评估具有一定的临床应用价值。Objective Serum abnormal prothrombin （PIVKA-Ⅱ） level was detected in pancreatic cancer patients and its clinical value in diagnosing and treating pancreatic cancer was explored. Methods A total of 112 pancreatic cancer patients, 28 benign pancreatic diseases patients and 79 healthy controls were collected from Cancer Hospital of Hubei Province. Serum PIVKA- Ⅱ level was determined by chemiluminescent immunoassay （CLIA）. CEA and CA19-9 level was detected by electroehemilumineseence immunoassay （ECLIA）. Receiver operation characteristic （ROC） curve was drawn and the cut-off value was set. The sensitivity, specificity and accuracy were calculated. Results PIVKA-I/ level in 112 pancreatic cancer patients was 39.0 （ 22.61, 137.67 ） U/L [ median （ quartile range） ], which was significantly higher than that in 30 patients with benign pancreatic disease [ 23.0 （ 17.32, 29.67 ） U/L ] and 79 healthy controls [ 21.21 （ 17.9, 25.12） U/L]. The differences were statistically significant （P〈0.01）. However, there was no significant difference between benign pancreatic disease patients and healthy controls. ROC analysis showed that area under curve（AUC） for PIVKA-Ⅱ , CEA and CA19-9 was 0.793, 0.707 and 0. 849. The cut-off value for discriminating pancreatic cancer was established at 32.4, 4.7 and 27.0 U/L for PIVKA- Ⅱ , CEA and CA19- 9. The sensitivity was 61.6% , 38.0% and 66.1% , and the specificity was 86.3% , 96.3% and 89.9%,and the accuracy was 71.7%, 62.3% and 75.0%, respectively. The sensitivity, specificity and accuracy of PIVKA-Ⅱ combined with CEA and CA19-9 was 90.2% , 76.0% and 84.3%. The sensitivity was obviously higher, while the specificity was lower. Serum PIVKA-Ⅱ level was associated with advanced tumor stage. There were 20 patients who were followed up. PIVKA-Ⅱ level in 15 cases were decreased after surgery or interventional therapy （50.6 U/L vs 110.5 U/L, P 〈0. 001 ）, which was increased in 4 of the five cases who received palliative care to a various

关 键 词：胰腺肿瘤 异常凝血酶原 诊断 监测 

分 类 号：R735.9[医药卫生—肿瘤] R730.43[医药卫生—临床医学]