PIVKA-Ⅱ联合AFP检测在原发性肝癌中的诊断价值  

The value of PIVKA-Ⅱ combined with AFP in the diagnosis of primary liver cancer

作　　者：刘前程[1] 王强[2] 卢小岚[2] 王东生[2] LIU Qiancheng;WANG Qiang;LU Xiaolan;WANG Dongsheng(Department of Clinical Laboratory,Mianyang People＇s Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市人民医院检验科,四川绵阳621000 [2]川北医学院医学检验系附属医院检验科转化医学研究中心,四川南充637000

出　　处：《中国热带医学》2018年第9期866-869,共4页China Tropical Medicine

摘　　要：目的探讨异常凝血酶原(PIVKA-Ⅱ)在原发性肝癌患者血清中的表达水平及其联合甲胎蛋白(AFP)检测在原发性肝癌中的诊断价值。方法收集88例原发性肝癌患者血清,同时收集61例胆囊相关疾病(包括胆囊癌、胆囊结石等)患者、110例肝脏良性疾病(包括慢性乙型肝炎、肝硬化等)患者、49例其他器官疾病(包括肺、消化道、胰腺等)患者以及110例健康体检人群血清作为对照。用化学发光法检测所有血清PIVKA-Ⅱ水平,用电化学发光法检测AFP水平。比较肿瘤标志物在各组间的表达水平,ROC曲线分析两种肿瘤标志物单独及联合应用对原发性肝癌的诊断价值。结果原发性肝癌组血清PIVKA-Ⅱ和AFP水平均高于其他疾病组,差异均有统计学意义(P<0.01)。ROC曲线分析表明,血清PIVKA-Ⅱ和AFP的诊断临界值分别设定为140.26 m Au/m L和184.60 ng/m L时,其在诊断原发性肝癌中的ROC曲线下面积(AUC)分别为0.943(95%CI:0.913~0.974)和0.876(95%CI:0.829~0.922)、敏感性分别为84.10%和58.00%、特异性分别为95.50%和97.60%。PIVKA-Ⅱ联合AFP诊断原发性肝癌的AUC最大,为0.960(95%CI:0.938~0.982),敏感性为89.80%,特异性为92.70%。结论 PIVKA-Ⅱ诊断原发性肝癌的价值明显优于AFP,PIVKA-Ⅱ联合AFP检测将有助于提高原发性肝癌诊断的价值。Objective To investigate the expression level of protein induced by vitamin K absence or antagonist-Ⅱ（PIVKA-Ⅱ） in sera of primary liver cancer patients and the value of abnormal prothrombin combined with alpha-fetoprotein（AFP） in the diagnosis of primary liver cancer. Methods The sera of 88 patients with primary liver cancer were collected.Meanwhile, the sera of 61 patients with gallbladder disease（gallbladder cancer, gallstone, etc.）, 110 patients with benign liverdiseases（chronic hepatitis B, cirrhosis, etc.）, 49 patients with other organ diseases（lung, digestive tract, pancreas, etc.） and 110 healthy peoples were collected respectively as the controls. The PIVKA-Ⅱ levels and AFP in the sera were detected by themethods of chemiluminescent immunoassay and electrochemical luminescence respectively. The expression levels of tumormarkers in each group were compared, and the receiver operating characteristic（ROC） curve was applied to evaluate theefficacy of individual and combined application of each maker in the diagnosis of primary liver cancer. Results The PIVKA-Ⅱ levels and AFP in the sera of the primary liver cancer group were significantly higher than all other disease groups（all P〈0.01）. ROC curve analysis showed that with the critical value of PIVKA-Ⅱ and AFP in serum were 140.26 m Au/m L and184.60 ng/m L in the diagnosis of primary liver cancer, the area under the ROC curve（AUC） were 0.943（95%CI：0.913-0.974）and 0.876（95% CI：0.829-0.922） respectively; the sensitivity were 84.10% and 58.00%; the specificity were 95.50% and97.60%. The AUC of PIVKA-Ⅱ combined with AFP in the diagnosis of primary liver cancer was 0.960（95%CI：0.938-0.982）,the sensitivity and specificity were 89.80% and 92.70% respectively. Conclusion The value of PIVKA-II in the diagnosis ofprimary liver cancer is obviously better than that of AFP. The combined detection with AFP will be helpful to improve thediagnostic efficacy of primary liver cancer.

关 键 词：异常凝血酶原(PIVKA-Ⅱ) 甲胎蛋白 原发性肝癌 

分 类 号：R735.7[医药卫生—肿瘤]