TEMs在AFP阴性及肿瘤体积≤3cm肝细胞癌中的诊断价值  

Diagnosis value of peripheral blood TEMs percentage in the AFP negative early hepatocellular carcinoma

作　　者：毛丽萍 王德麟[1] 韩刚[1] 付守忠[2] 王建新[3] 王跃国[4] 

机构地区：[1]南通市第三人民医院检验科,江苏226006 [2]南通市第三人民医院介入科,江苏226006 [3]南通市第三人民医院肝胆外科,江苏226006 [4]南通大学附属医院检验科

出　　处：《中华检验医学杂志》2018年第2期126-131,共6页Chinese Journal of Laboratory Medicine

摘　　要：目的探讨外周血中TEMs占CD14＋CD16＋单核细胞百分比在AFP阴性及肿瘤体积≤3 cm肝细胞癌（HCC）中的诊断价值。方法通过流式细胞术检测肝细胞癌组82例、肝硬化（LC）组29例、慢性乙型肝炎（CHB）组28名和健康对照（NC）组31例外周血TEMs占CD14＋CD16＋单核细胞百分比，同时采用美国雅培i2000微粒子化学发光免疫分析仪检测其血浆AFP水平。多组比较采用Kruskal－Wallis H检验，两两比较用Mann－Whitney U检验，率的比较采用χ2检验，Spearman秩相关分析TEMs与AFP相关性，分析TEMs诊断HCC、AFP阴性及肿瘤体积≤3 cm肝细胞癌的受试者工作曲线下面积（ROC－AUC）、敏感度及特异度。结果在HCC组、AFP阴性肝癌组及肿瘤体积≤3 cm肝细胞癌组中TEMs均高于LC、CHB及NC组，P均小于0.05。TEMs和AFP诊断HCC的ROC－AUC分别为0.701（95% CI 0.626～0.768）、0.712（95% CI 0.638～0.779）。当TEMs和AFP的最佳cut－off值设为4.95%和20 μg/L时，其诊断HCC的敏感度分别为71.95%和45.12%，特异度分别为70.45%和85.23%，TEMs的敏感度显著高于AFP（χ2＝12.16, P＝0.000），但AFP的特异度高于TEMs （χ2＝5.57，P＝0.018）。采用TEMs/AFP方案其诊断HCC敏感度最高（89.02%），采用TEMs＋AFP方案时诊断特异度最高（93.18%）。TEMs与AFP对26例肿瘤体积≤3 cm HCC的ROC－AUC无显著性差异（0.776 vs 0.645，Z＝1.805，P＝0.071）。采用TEMs/AFP方案其诊断肿瘤体积≤3 cm HCC灵敏度最高（84.62%），采用TEMs＋AFP方案时诊断特异度最高（93.18%）。TEMs对45例AFP阴性HCC患者鉴别诊断的ROC－AUC为0.739（95% CI 0.648～0.829），其诊断灵敏度和特异度分别为80.0%和70.45%。Spearman秩相关分析82例HCC患者TEMs与AFP水平显示两指标间无相关性（r＝－0.169，P＝0.129）结论TEMs对AFP阴性和肿瘤体积≤3 cm肝细胞癌有一定诊断价值，且两指标在诊断HCC患者时可以互相补充。ObjectiveTo evaluate the diagnosis value of the percentage of Tie2-expressing monocytes （TEMs） in CD14＋ CD16＋ monocytes of peripheral blood from hepatocellular carcinoma （HCC） patients with negative AFP and tumor size≤3 cm.MethodsFlow Cytometry （FCM） was used to determine the percentage of TEMs in CD14＋ CD16＋ monocytes of peripheral blood from patients with HCC （n=82）, liver cirrhosis （n=29）, chronic hepatitis B （n=28）, and healthy controls （n=31）. Abbott i2000 microparticle chemiluminescence immunoassay analyzer was used to determine the plasma alpha-fetoprotein （AFP） levels. The difference among multi groups was analyzed by the Kruskal-Wallis H test. Two independent groups were analyzed by the Mann-Whitney U test. The chi-square test was used in the rate comparison. The correlation between TEMs and AFP was analyzed by Spearman rank correlation analysis. Morever, the areas under the receiver operating characteristic curves （ROC-AUC）, sensitivity and specificity of TEMs or AFP in differentiating HCC, HCC with AFP negative or tumor size≤3 cm were analyzed.ResultsThe percentage of TEMs in CD14＋ CD16＋ monocytes of peripheral blood from HCC or HCC with negative AFP or HCC with tumor size≤3 cm was significantly higher than that in patients with liver cirrhosis, chronic hepatitis B and healthy controls（P〈0.05）. ROC-AUC of TEMs and AFP in the diagnosis of HCC were 0.701 （95% CI 0.626-0.768） and 0.712（95% CI 0.638-0.779）respectively. When the cut-off values of TEMs and AFP were 4.95% and 20 μg/L, the sensitivities of TEMs and AFP were 71.95% and 45.12%, and the specificities of TEMs and AFP were 70.45% and 85.23% . The sensitivity of TEMs in the diagnosis of HCC was significantly higher than that of AFP （χ2=12.16, P=0.000） . The specificity of AFP was significantly higher than that of TEMs （χ2=5.57, P=0.018）. There was a highest sensitivity （89.02%） in TEMs/AFP method, and there was a highest specificity （93.18%） in TEMs＋ AFP method

关 键 词：癌  肝细胞 肝肿瘤 甲胎蛋白类 受体  TIE-2 单核细胞 

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