PIVKA-Ⅱ和AFP对原发性肝癌诊断价值的评估  

Evaluation of PIVKA-Ⅱ and AFP in diagnosis of primary hepatic carcinoma

作　　者：罗丽丹[1] 张斌[2] 李江[3] 胡小宣[1] LUO Lidan;ZHANG Bin;LI J iang;HU Xiaoxcuan(Department of Hepatolog y,Pepol＇s Hospital of Hu＇nan Province,Changsha,Hu＇nan 410005,China;Department of Radiology,Second Xiangya Hospital of Central South University,Changsha,Hu＇nan 410005,China;Department of Clinical Laboratory,Pepol＇s Hospital of Hu＇nan Province,Changsha,Hu＇nan 410005,China)

机构地区：[1]湖南省人民医院肝病内科,长沙410005 [2]中南大学湘雅二医院放射科,长沙410005 [3]湖南省人民医院检验科,长沙410005

出　　处：《国际检验医学杂志》2018年第14期1721-1724,共4页International Journal of Laboratory Medicine

基　　金：湖南省科技计划项目(2015SK2048)

摘　　要：目的检测原发性肝癌(PHC)患者维生素K缺乏或拮抗剂-Ⅱ诱导蛋白(PIVKA-Ⅱ)和甲胎蛋白(AFP)水平,探讨两者单项和联合检测对肝癌的诊断价值。方法回顾性研究250例肝病患者,其中病毒性肝炎组39例、肝硬化组112例和PHC组99例(Ⅰ期19例、Ⅱ期17例、Ⅲ期39例和Ⅳ期24例),对各组患者PIVKA-Ⅱ和AFP的检测结果进行统计分析。结果各期PHC组PIVKA-Ⅱ水平均显著高于病毒性肝炎组和肝硬化组,各期PHC组AFP水平均高于肝硬化组,Ⅲ期PHC组AFP水平高于病毒性肝炎组。绘制受试者工作特征曲线(ROC曲线),PIVKA-Ⅱ和AFP检测肝癌的ROC曲线下面积(AUC)分别为0.884、0.788,两者联合检测的AUC为0.892。PIVKA-Ⅱ检测肝癌灵敏度和特异度分别为80.81%、84.11%,其灵敏度高于AFP,两者并联检测灵敏度提高到86.87%,串联检测特异度提高到97.35%。结论 PIVKA-Ⅱ在PHC筛查、诊断等方面具有良好的临床运用价值,是一项优于AFP的肿瘤标志物,两者联合检测有助于提高肝癌的诊断效能。Objective To compare the diagnostic values of protein induced by vitamin K absence or antagonist-Ⅱ（PIVKA-Ⅱ）and alpha fetoprotein（AFP）individually and in combination to find the best biomarker or biomarker panel for the diagnosis of primary hepatic carcinoma（PHC）.Methods The study groups consisted of 99 PHC group（including 19 Ⅰ stage,17 Ⅱ stage,39 Ⅲ stage and 24 Ⅳ stage）,39 patients with chronic hepatitis group and 112 patients with hepatic cirrhosis group.All patients were examined for serum levels of PIVKA-Ⅱ and AFP.Results The mean level of PIVKA-Ⅱ in patients with PHC was significantly higher than those in chronic hepatitis group and hepatic cirrhosis group,respectively.The levels of AFP in every stage of PHC were higher than that of hepatic cirrhosis group,and the levels of serum AFP in PHC Ⅲ stage were greater than those in chronic hepatitis group.ROC analyses were also applied to all combinations of the markers.When the two biomarkers were analyzed individually,PIVKA-Ⅱ showed larger AUC（0.884）than AFP（0.788）.For combinations of the biomarkers,the AUC was the highest（0.892）.The sensitivity and specificity of PIVKA-Ⅱ were 80.81%and 84.11%respectively in diagnosis of PHC.The sensitivity and specificity of combinations could be improved to 86.87% and 97.35% with parallel and serial detection.ConclusionPIVKA-Ⅱ can serve as a marker for screening and diagnosising PHC.Its diagnostic value is higher than AFP.Combinations of the two biomarkers may improve detection of the primary hepatic carcinoma.

关 键 词：原发性肝癌 维生素K缺乏或拮抗剂-Ⅱ诱导蛋白 甲胎蛋白 诊断 

分 类 号：R735.7[医药卫生—肿瘤]