AFP与PIVKA-Ⅱ联合检测在原发性肝癌诊断中的应用研究  

Diagnostic Value of Joint Detection of AFP and PIVKA-Ⅱ in Hepatocellular Carcinoma

作　　者：黄述婧 姜菲菲[1] 王颖[1] 于艳华[1] 娄金丽[1] 

机构地区：[1]首都医科大学附属北京佑安医院临床检验中心,北京100069

出　　处：《标记免疫分析与临床》2016年第10期1134-1138,1128,共6页Labeled Immunoassays and Clinical Medicine

基　　金：佑安肝病艾滋病基金(YNKT20160037)

摘　　要：目的探究甲胎蛋白AFP与异常凝血酶原PIVKA-Ⅱ对原发性肝癌的诊断价值。方法回顾性研究首都医科大学附属北京佑安医院2016年1月至3月收治的肝病患者268例,其中病毒性肝炎患者59例、肝硬化患者96例、其他肝病患者33例和原发性肝癌患者80例(早期50例、晚期30例),对其AFP和PIVKA-Ⅱ的检测结果进行统计分析。结果原发性肝癌组血清AFP和PIVKA-Ⅱ水平明显高于其他疾病组(P<0.005);AFP和PIVKA-Ⅱ的ROC曲线下面积分别为0.854和0.926,两指标联合诊断原发性肝癌的ROC曲线下面积为0.951;血清AFP单独诊断原发性肝癌的敏感性和特异性分别为87.50%和66.49%,PIVKA-Ⅱ单独诊断原发性肝癌的敏感性和特异性分别为90.00%和85.11%。联合检测对原发性肝癌的诊断效率,并联联检可将敏感性提高到97.50%;串联联测可将特异性提高到94.15%;经相关性分析发现,在早期原发性肝癌的诊断上两指标Spearman相关系数为0.044(P=0.763),两者无相关性。结论血清PIVKA-Ⅱ用于诊断原发性肝癌有较高的敏感性和特异性,其诊断价值高于AFP;两指标在早期原发性肝癌的诊断上没有相关性,两指标联合可以明显提高早期原发性肝癌的诊断效率。Objective To evaluate diagnostic value of alpha fetoprotein （AFP）and protein induced by vitamin K absence or antagonist-II （PIVKA-II） in primary hepatic carcinoma （PHC）. Methods Retrospective study on 59 hepatitis patient, 96 cirrhotic patients, 33 other liver disease and 80 patients with hepatocellular carcinoma in Beijing Youan Hospital from January 2016 to March 2016. The levels of AFP and PIVKA-U in serum were analyzed. Results The levels of serum AFP and PIVKA-II in hepatocellular carcinoma group were significantly higher than those in other groups （ P 〈 0. 005 ）. ROC curve analysis showed that the areas under the curve of AFP and PIVKA-II were 0. 854 and 0. 926. The sensitivities of AFP and PIVKA-II were 87.50% and 90. 00% respectively, while the specificities were 66. 49% and 85. 11% respectively in diagnosis of hepatocellular carcinoma. The sensitivity and specificity of two combined could be improved to 97.50% and 94. 15% with parallel and serial detection. The Spearman correlation coefficient of the two indexes was 0.044 （ P = 0. 763 ）. Conclusion Serum PIVKA-II has a high sensitivity and specificity in diagnosis of hepatocellular carcinoma. Its diagnostic value is higher than the AFP. The two markers used alone are not reliable in diagnosisof early PHC. Joint detection of AFP and PIVKA-II has higher sensitivity and specificity, which may improve early detection of the hepatocellular carcinoma.

关 键 词：原发性肝癌 甲胎蛋白 异常凝血酶原 

分 类 号：R735.7[医药卫生—肿瘤] R730.43[医药卫生—临床医学]