AFP、PIVKA-Ⅱ联合AFP-L3诊断肝硬化患者合并肝癌的价值研究  

The Value Research on the Combination of AFP,PIVKA-Ⅱ,and AFP-L3 as Tumor Markers to Detect Hepatocellular Carcinoma in Cirrhotic Patients

作　　者：秦燕[1] 肖毅[1] 王曦[2] 彭燕[1] 谢静[1] 曲远青 赵鑫[3] 

机构地区：[1]成都军区总医院检验科,成都610083 [2]成都军区总医院超声科,成都610083 [3]成都市第七人民医院检验科,成都610071

出　　处：《成都医学院学报》2016年第5期585-588,591,共5页Journal of Chengdu Medical College

摘　　要：目的探索甲胎蛋白（AFP）和异常凝血酶原Ⅱ（PIVKA-Ⅱ）联合甲胎蛋白异质体（AFP-L3）在肝硬化患者中诊断肝癌的价值。方法回顾性分析261例肝硬化合并肝癌患者实验室检查结果作为试验组,同时纳入202例肝硬化未合并肝癌患者实验室检查结果作为对照组,采用ROC曲线分析3者单独运用及联合运用在诊断肝癌及早期肝癌中的价值。结果 463例患者中,男301例（65%）,乙肝患者321例（69%）。ROC曲线分析显示：AFP、PIVKA-Ⅱ和AFP-L3单独运用诊断肝癌的曲线下面积分别为0.771（95%CI,0.731~0.811）、0.809（95%CI,0.764~0.854）和0.758（95%CI,0.728~0.789）。3者联合运用诊断肝癌曲线下面积提高为0.882（95%CI,0.851~0.914）,诊断敏感性和特异性分别为88.6%和75.1%。AFP、PIVKA-Ⅱ和AFP-L3单独运用诊断早期肝癌的曲线下面积分别为0.744（95%CI,0.698~0.791）、0.718（95%CI,0.664~0.773）和0.678（95%CI,0.604~0.752）。3者联合运用诊断早期肝癌曲线下面积提高为0.773（95%CI,0.704~0.842）,诊断敏感性和特异性分别为87.6%和73.2%。结论 AFP、PIVKA-Ⅱ和AFP-L3联合运用相对于单独运用各指标可明显提高肝硬化患者中肝癌及早期肝癌的诊断率。Objective To investigate the diagnostic value of the combination of alpha-fetoprotein（AFP）,protein induced by vitamin K absence or antagonist-Ⅱ（PIVKA-Ⅱ）and lens culinaris agglutinin-reactive fraction of AFP（AFP-L3）as tumor markers to detect hepatocellular carcinoma（HCC）in cirrhotic patients.Methods The retrospective method was used to analyze the laboratory data of 261 cirrhotic patients with HCC in the experiment group and those of 202 cirrhotic patients without HCC occurrence in the control group.The receiver operating characteristic curve（ROC）was used to analyze the value of the individual markers and the combined markers in diagnosing HCC and early HCC in cirrhotic patients.Results Among the 463 patients,65% patients（n=301）were male and 69% cases（n=321）were patients with chronic hepatitis B.When AFP,PIVKA-Ⅱ,and AFP-L3 were used as the individual tumor marker,the areas under the receiver operating characteristic curve（AUROC）for HCC diagnosis were 0.771（95% CI,0.731-0.811）for AFP,0.809（95% CI,0.764-0.854）for PIVKA-Ⅱ,and0.758（95% CI,0.728-0.789）for AFP-L3 respectively,and the AUROC for early HCC diagnosis were 0.744（95% CI,0.698-0.791）for AFP,0.718（95% CI,0.664-0.773）for PIVKA-Ⅱ,and 0.678（95% CI,0.604-0.752）for AFP-L3 respectively.When AFP,PIVKA-Ⅱ,and AFP-L3 were used as the combined tumor marker,the AUROC increased to 0.882（95% CI,0.851-0.914）for HCC diagnosis and 0.773（95% CI,0.704-0.842）for early HCC diagnosis respectively,and the sensitivity and specificity were 88.6% and 75.1% in overall HCC diagnosis,and 87.6% and 73.2% in early HCC diagnosis respectively.Conclusion The diagnostic accuracy is much higher by combining AFP,PIVKA-Ⅱ,and AFP-L3 as the tumor markers than by using them individually in detecting HCC and early HCC in cirrhotic patients.

关 键 词：甲胎蛋白 甲胎蛋白异质体 异常凝血酶原Ⅱ 肝细胞肝癌 

分 类 号：R735.7[医药卫生—肿瘤]