PIVKA-Ⅱ和AFP联合检测对原发性肝癌的诊断价值  

Clinical Value of Serum PIVKA-lI and AFP Detection for Primary Hepatocellular Carcinoma

作　　者：周淑燕[1] 卓传尚[1] 柳丽娟[1] 吴绍贵 李圣聪[1] 谢海花[1] 

机构地区：[1]福州市传染病医院检验科,福州350025

出　　处：《现代检验医学杂志》2017年第1期69-71,76,共4页Journal of Modern Laboratory Medicine

基　　金：福建中医药大学校管课题临床专项(XB2015071)

摘　　要：目的探讨血清异常凝血酶原(PIVKA-Ⅱ)和甲胎蛋白(AFP)在原发性肝癌(PHC)诊断中的应用价值。方法收集2014年11月~2015年3月福州市传染病医院178例住院患者的血清,包括54例原发性肝癌患者、39例肝硬化患者、55例慢性乙型肝炎患者和30例健康者,采用LUMI-PULSE G1200全自动免疫分析仪和雅培i2000化学发光免疫分析仪分别检测血清PIVKA-Ⅱ和AFP水平,分析PIVKA-Ⅱ和AFP二者单独及联合检测诊断PHC的受试者工作特征曲线下面积(ROC-AUC)、敏感度和特异度。结果肝癌组的PIVKA-Ⅱ水平为274 mAU/ml,高于肝硬化组(23 mAU/ml)、肝炎组(26 mAU/ml)和健康组(21 mAU/ml)(P均<0.001),肝癌组的AFP水平为84.0 ng/ml,高于肝硬化组(21.78 ng/ml)和健康组(2.8 ng/ml)(P分别为0.043和0.001),但与肝炎组(66.8 ng/ml)比较,差异无统计学意义(P=0.585);PIVKA-Ⅱ诊断PHC的曲线下面积(AUC)为0.776,高于AFP(0.649),(Z值=2.262,P=0.023 7);单独检测PIVKA-Ⅱ(≥40mAU/ml)诊断肝癌的敏感度和特异度分别为78.52%和78.23%,AFP(≥10 mg/ml)的敏感度和特异度分别为77.78%和34.64%,二者联合检测可以提高肝癌诊断的敏感度为85.19%(vs PIVKA-Ⅱ,P=0.031;vs AFP,P=0,016)和特异度为85.48%(vs PIVKA-Ⅱ,P=0.004;vs AFP,P=0.001)。结论 PIVKA-Ⅱ对PHC的诊断具有较高的临床应用价值,其与AFP联合检测可以提高PHC诊断的敏感度与特异度。Objective To discuss the clinical value of protein induced by vitaminK absence antagonist- Ⅱ（PIVKA-Ⅱ ） and al- pha-fetoprotein （AFP） in diagnosing primary hepatocellular carcinoma （PHC）. Methods There were 178 samples from in- patients in Fuzhou Infectious Disease Hospital,including 54 patients with PHC, 39 patients with liver cirrhosis, 55 patients with hepatitis and 30 cases of healthy. Serum levels of PIVKA-Ⅱ and AFP levels were detected by LUMI-PULSEG1200 automatic immunity analyzer and Abbott automatic immunity analyzer respectively, and the difference between the levels was compared. Analyzed the areas under the receiver operating characteristic curves （ROC-AUC） and compared the sensitivity and specificity of single PIVKA-Ⅱ or AFP assay,and the combined detection of PHC. Results The serum level of PIVKA- Ⅱ in hepatocellular carcinoma group was 274 mAU/ml,which was higher than that in liver cirrhosis group （23 mAU/ml）, chronic hepatitis group （26 mAU/ml） and healthy group （21 mAU/ml）（P〈0. 001）,and the levels of AFP in PHC group was 84.0 ng/ml,which was higher than that in liver cirrhosis （21.78 ng/ml） and healthy groups （2.8 ng/ml）. But it was not statistically significant （P=0. 585） compared with those in the chronic hepatitis group （66.8 ng/ml）, the results of re- ceiver operating characteristic （ROC） curve showed that the area under the curve of PIVKA-Ⅱ was 0. 776,higher than the AFP （0. 649） ,（Z=2. 262,P=0. 023 7）. Serum PIVKA- Ⅱ （≥40 mAU/ml） had a sensitivity of 78. 52% and a speciffcity of 76.23% in the diagnosis of PHC,While serum AFP （≥10 mg/ml） had a sensitivity of 77. 78% and a specificity of 34.64% in the diagnosis of PHC. A combination of serum levels of PIVKA-Ⅱ and AFP could increase the sensitivity in the diagnosis of PHC （vs PIVKA-Ⅱ ,P=0. 031;vs AFP,P=0. 016） and specificity （vs PIVKA-Ⅱ ,P=0. 004;vs AFP,P=0. 001）. Conclusion Serum PIVKA-Ⅱ have high clinical application values in diagnosing P

关 键 词：异常凝血酶原 甲胎蛋白 原发性肝癌 

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