血清PIVKA-Ⅱ测定在41例HCC诊断中的应用及其特异性分析  

Application of Serum PIVKA-Ⅱ in the Diagnosis of 41 Patients with HCC and the Analysis of Its Pecificity

作　　者：宋正霞 丁芹 秦亚楠 洪雷 张言超 颜学兵 

机构地区：[1]徐州医科大学附属医院感染性疾病科,221000

出　　处：《医学研究杂志》2017年第8期19-21,59,共4页Journal of Medical Research

基　　金：国家自然科学基金资助项目(面上项目)(81371867);江苏省高校自然科学基础研究基金资助项目(08KJD320012)

摘　　要：目的分析人异常凝血酶原即维生素K缺乏或拮抗剂Ⅱ诱导蛋白(protein induced by vitamin K absence or antagonist-Ⅱ,PIVKA-Ⅱ)在慢性乙型肝炎、肝细胞癌及梗阻性黄疸患者血清中的表达特点,评价其在肝细胞癌的诊断价值。方法检测徐州医科大学附属医院131例患者血清PIVKA-Ⅱ、甲胎蛋白(AFP)浓度,包括慢性乙型肝炎74例,梗阻性黄疸16例,肝细胞癌41例。结果肝细胞癌组患者血清PIVKA-Ⅱ水平高于慢性乙型肝炎组、梗阻性黄疸组(P均<0.05)。PIVKA-Ⅱ诊断肝细胞癌的敏感度和特异性分别为73.17%、85.14%,AFP分别为68.29%、51.35%;平行诊断实验的敏感度为85.37%。在肝细胞癌患者中,肿瘤直径>5cm患者的PIVKA-Ⅱ水平明显高于直径≤5.0cm患者,差异有统计学意义(P<0.05);T_3、T_4期患者PIVKA-Ⅱ的水平明显高于T_1、T_2期患者,差异有统计学意义(P<0.05)。结论梗阻性黄疸患者血清PIVKA-Ⅱ无明显升高。肝炎活动会引起PIVKA-Ⅱ水平变化,但是低于正常上限。血清PIVKA-Ⅱ在诊断肝细胞癌的敏感度和特异性均高于AFP,联合诊断可提高敏感度。外周血PIVKA-Ⅱ水平与肿瘤直径、TNM分期有关。Objective To analyze the characteristic expression of serum protein induced by vitamin K absence or antagonist - Ⅱ ex- pressed in patients with chronic hepatitis B or cirrhosis, obstructive joundice and hepatocellular carcinoma and estimated its diagnostic val- ue in hepatoeellular carcinoma. Methods Patients with chronic hepatitis B （n =74） , obstructive joundice （n = 16） and HCC（n =41） were from the Affiliated Hospital of Xuzhou Medical University, whose serum level of PIVKA - Ⅱ and AFP was detected. Results The serum level of PIVKA -Ⅱ in HCC group were higher than that in chronic hepatitis B and obstructive joundice groups （ P 〈 0. 05 ）. The sensitivity and pecificity of PIVKA - Ⅱ were respectively 73.17% and 85.14% , AFP respectively 68.29% and 51.35%. The sensitivity of parallel diagnosis was 85.37%. Serum level of PIVKA -Ⅱ in HCC patients which tumor diameter less than 5cm was higher than that tumor diameter no more than 5cm（P 〈0.05）. Serum level in HCC patients from Ⅲ - Ⅳ stages was higher than that from Ⅰ - Ⅱ stages （P 〈 0. 05）. Conclusion The serum level of PIVKA - Ⅱ in patienrs with obstructive joundice was low. Activation of hepatitis could re- sult in the change of serum PIVKA - Ⅱ level, but below the upper limit of normal. The sensitivity and pecificity of PIVKA - Ⅱ in diagno- sing HCC were both higher than AFP, and the combined detection of PIVKA - Ⅱ and AFP could increase the sensitivity. The serum lev- els of PIVKA - Ⅱ were related to tumor size and tumor stages.

关 键 词：PIVKA-Ⅱ 梗阻性黄疸 肝细胞癌 乙型肝炎 

分 类 号：R5[医药卫生—内科学]