应用异常凝血酶原在乙型肝炎病毒感染者中筛查HCC研究进展  

PIVKA-Ⅱ as a screening marker for hepatocellular carcinoma in patients with hepatitis B virus infection

作　　者：赵琴[1,2] 刘园园[1] 雷旭[1] 雷飞飞[1] 李刚[1] 李芳[1] 李金科[1] 杨靖[1] 刘龙[1] 谭华炳[1] Qin Zhao Yuan-Yuan Liu Xu Lei Fei-Fei Lei Gang Li Fang Li Jin-Ke Li .ling Yang Long Liu Hua-Bing Tan(Institute of Liver Disease, Renmin Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China Clinical Laboratory, Fang County Renmin Hospital, Shiyan 442100, Hubei Province, China)

机构地区：[1]湖北医药学院附属人民医院肝病研究所,湖北省十堰市442000 [2]房县人民医院检验科,湖北省十堰市442100

出　　处：《世界华人消化杂志》2017年第9期803-809,共7页World Chinese Journal of Digestology

摘　　要：我国是乙型肝炎病毒(hepatitis B virus,HBV)感染高发地区,由HBV感染引起的肝癌(hepatocellular carcinoma,HCC)占HCC患者的80%,我国的HCC患者占世界HCC患者的53.5%.与HCC危害相反,我国HCC确诊后80%为中晚期HCC,失去最佳治疗机会.在HBV感染者中早期筛查HCC患者是肝病学界一直在探索的问题.既往用于筛查HCC的指标甲胎蛋白(a-fetoprotein,AFP)敏感性较低,几乎有1/3的HCC检测阴性.寻找敏感性高、特异性高的HCC早期筛查项目成为肝病学界研究的热点.异常凝血酶原也称为维生素K缺乏诱导的蛋白质(protein induced by vitamin K absence,PIVKA-Ⅱ)由HCC细胞分泌,HCC患者血中PIVKA-Ⅱ水平升高是HCC细胞的特性,检测血中PIVKA成为筛查HCC较理想的指标.本文通过综述国内外文献,得出以下结论 :(1)PIVKA-Ⅱ是HCC的产物;(2)PIVKA-Ⅱ与HCC病情关系密切,应用PIVKA-Ⅱ在HBV感染者中诊断HCC和判断预后是可行的;(3)将应用PIVKA-Ⅱ筛查HCC的标准定为40 mAU/mL,有利于提高敏感性和特异性;(4)PIVKA-Ⅱ联合AFP筛查HCC,有利于提高诊断的敏感性和特异性,在AFP阴性HCC患者的PIVKA-Ⅱ和AFP联合检测意义更大;(5)PIVKA-Ⅱ在国内外众多指南中被指定为HCC筛查指标.Hepatitis B virus（HBV） infection is highly prevalent in China.Hepatocellular carcinoma（HCC） is the sixth most common cancer in the world,and HBV infection is the most common predisposing factor for HCC.China has 53.3%of HCC cases worldwide and 80%of HCC cases are related to HBV-associated hepatitis.HCC grows silently with mild or no symptoms until advanced.Due to the absence of effective treatment for advanced stage hepatic cancer,screening for high-risk population for early detection is of particular importance.Alpha fetoprotein（AFP） is the most widely used biomarker for HCC surveillance,but has a sensitivity of only 60%,and it is easy to be effected by other factors.Studies have suggested that the level of prothrombin induced by vitamin K absence-Ⅱ（PIVKA-Ⅱ） in serum（40 mAU/mL） could be used as a predictive biomarker of HCC.PIVKA-Ⅱ proved to be superior to AFP for early detection of HCC with regard to higher sensitivity and specificity.Furthermore,PIVKA-Ⅱ can be used to discriminate between different histopathological grades of HCC.The combined detection of PIVKA-Ⅱ and AFP in HCC is important for early diagnosis,therapeutic efficiency and prognosis evaluation,especially in AFP-negative HCC.

关 键 词：肝细胞肝癌 筛查 异常凝血酶原 甲胎蛋白 研究进展 

分 类 号：R735.7[医药卫生—肿瘤]