肿瘤标记物在肝癌患者血清中的表达及其诊断价值  

Expression and diagnostic value of serum tumor markers in patients with hepatic cancer

作　　者：羊文芳 郑文雯[3] 苏显都[4] 余平[1] YANG Wenfang ZHENG Wenwen SU Xiandu YU Ping(Department of Immunology, College of Basic Medical Sciences, Xiangya School of Medicine, Central South University, Changsha 410013, Hu＇nan Province, China Department of Clinical Laboratory, the First People＇s Hospital of Danzhou, Danzhou 571700, Hainan Province, China Department of Clinical Laboratory, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China Department of Clinical Laboratory, Hainan Nongken Nada Hospital, Danzhou 571700, Hainan Province, China)

机构地区：[1]中南大学湘雅医学院基础医学免疫学系,湖南长沙410013 [2]儋州市第一人民医院检验科,海南儋州571700 [3]中山大学第六附属医院检验科,广东广州510655 [4]海南省农垦那大医院检验科,海南儋州571700

出　　处：《解放军医学院学报》2016年第9期976-979,1000,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨血清高尔基体蛋白73（golgi protein 73,GP73）、磷脂酰肌醇蛋白聚糖3（glypican 3,GPC3）、甲胎蛋白（alpha-fatoprotein,AFP）、甲胎蛋白异质体3（alpha-fetoprotein Lens culinaris agglutiin 3,AFP-L3）、癌胚抗原（carcinoembryonic antigen,CEA）在原发性肝癌（primary hepatic cancer,PHC）中的表达及临床意义。方法招募2013年5月-2015年6月湘雅医院82例原发性肝癌、60例肝硬化、60例慢性肝炎患者及40例健康对照者。采用酶联免疫分析方法定量检测研究对象血清GP73和GPC3,微量离心柱法分离AFP-L3,电化学发光法测定AFP和CEA,并应用Logistic回归和ROC曲线评价各指标在PHC诊断中的价值。结果原发性肝癌组血清GP73、GPC3、AFP、AFP-L3、CEA水平均明显高于其他3组（P〈0.05）;肝硬化组血清GP73、GPC3、AFP、CEA水平均明显高于慢性肝炎组和对照组（P〈0.05）;慢性肝炎组血清GP73、GPC3、AFP、AFP-L3水平均明显高于对照组（P〈0.05）。原发性肝癌组血清GP73与GPC3、AFP、AFP-L3水平呈明显正相关（r=0.563,P=0.000;r=0.527,P=0.008;r=0.542,P=0.000）;肝硬化组血清GP73与GPC3、AFP-L3水平呈明显正相关（r=0.602,P=0.000;r=0.517,P=0.004）。ROC曲线分析显示,单项检测中AFP-L3的AUC为0.838（95%CI：0.760～0.891）和诊断准确性（84.7%）最高。血清肿瘤标记物5项联合检测的AUC为0.884（95%CI：0.836～0.947）和诊断准确性（89.6%）均高于各单项检测。多元Logistic回归分析显示,GP73、GPC3、AFP、AFP-L3和CEA进入回归模型,其对PHC的诊断模型为Logit P=2.63＋0.025GP73＋0.056GPC3＋0.011AFP＋0.015AFP-L3＋0.057CEA。结论血清肿瘤标记物可作为早期诊断和鉴别诊断PHC的良好指标,联合检测可明显提高诊断PHC的准确性。Objective To explore the expression of serum golgi protein 73（GP73）, glypican 3（GPC3）, alpha-fatoprotein（AFP）, alpha-fetoprotein Lens culinaris agglutiin 3（AFP-L3）, carcinoembryonic antigen（CEA） in primary hepatocellular carcinoma（PHC） and their clinical significance. Methods Eighty-two patients with PHC and 60 patients with liver cirrhosis, 60 patients with chronic hepatitis and 40 healthy controls in Xiangya Hospital from May 2013 to June 2015 were enrolled in this study. The serum GP73 and GPC3 were detected by enzyme-linked immunosorbent assay, and the AFP-L3 was separated by micro column method. Determination of AFP and CEA were tested by electrochemical luminescence method. Logistic regression and ROC curve were adopted to evaluate the values of these indexes in the diagnosis of PHC. Results The levels of serum GP73, GPC3, AFP, AFP-L3 and CEA in primary liver cancer group were significantly higher than those in other three groups（P 0.05）, the levels of serum GP73, GPC3, AFP, CEA in liver cirrhosis group were significantly higher than those in chronic hepatitis group and control group（P 0.05）, and the levels of serum GP73, GPC3, AFP, AFP-L3 in chronic hepatitis group were significantly higher than those in control group（P 0.05）. Serum GP73 was positively correlated with GPC3, AFP, AFP-L3 in primary hepatic cancer group（r =0.563, P =0.000; r =0.527, P =0.008; r =0.542, P =0.000）, and it was also positively correlated with GPC3 and AFP-L3 in liver cirrhosis group（r=0.602, P=0.000; r=0.517, P=0.004）. ROC curve analysis showed that the AUC（0.838, 95% CI： 0.760- 0.891） and diagnostic accuracy rate（84.7%） of AFP-L3 were the highest. Combination of serum tumor markers＇ AUC（0.884, 95% CI： 0.836-0.947） and the diagnostic accuracy rate（89.6%） were greater than the single detection. Multivariate Logistic regression analysis showed that GPC3, AFP, GP73, AFP-L3 and CEA entered the regression model, and the model was： Logit P=2.63 ＋ 0.025GP73 ＋0.056GP

关 键 词：原发性肝癌 血清肿瘤标记物 诊断 

分 类 号：R735.7[医药卫生—肿瘤]