血清PIVKA-Ⅱ与AFP检测在原发性肝细胞癌诊断中的应用  

Detection of Serum AFP and PIVKA-Ⅱ Levels for Diagnosis of Primary Hepatocellular Carcinoma

作　　者：侯帅 欧阳锡武 李荣华[3] 傅蕾[1] 符小玉[1] 郑宜翔[1] 彭仕芳[1] HOU Shuai;OUYANG Xi-wu;LI Rong-hua;FU lei;FU Xiao-yu;ZHENG Yi-xiang;PENG Shi-fang(Department of Infectious Diseases and Hunan Provincial Key Laboratory of Viral Hepatitis,Xiangya Hospital,Central South University,Changsha 410008,Hunan,China;Lirer Surgery,Xiangya Hospital,Central South University,Changsha 410008,Hunan,China;Endear Medicine,Xiangya Hospital,Central South University,Changsha 410008,Hunan,China)

机构地区：[1]中南大学湘雅医院感染病科和病毒性肝炎湖南省重点实验室,中国湖南长沙410008 [2]中南大学湘雅医院肝脏外科,中国湖南长沙410008 [3]中南大学湘雅医院核医学科,中国湖南长沙410008

出　　处：《生命科学研究》2019年第2期128-134,167,共8页Life Science Research

基　　金：国家自然科学基金资助项目(81770623);湘雅医院临床研究基金资助项目(2016L10);湖南省自然科学基金资助项目(2018JJ2657)

摘　　要：为探究血清PIVKA-Ⅱ与AFP检测在原发性肝细胞癌诊断中的优劣性,对237例患者的血清PIVKA-Ⅱ与AFP进行检测,其中乙肝病毒相关性原发性肝细胞癌(hepatocellular carcinoma, HCC)患者115例、乙肝携带者(asymptomatic carrier, As C) 55例、乙肝病毒相关肝硬化(liver cirrhosis, LC)患者47例、非肝癌肿瘤患者20例。检测结果显示:肝癌组PIVKA-Ⅱ的中位表达量高于非肝癌组(包括As C组、LC组、非肝癌肿瘤组), P均小于0.05;使用AFP、PIVKA-Ⅱ和AFP+PIVKA-Ⅱ诊断肝癌的灵敏度分别为67.8%、81.7%和90.4%,对应的ROC曲线下面积为0.881、0.945和0.962, PIVKA-Ⅱ检测肝癌的cut-off值为32 m AU/m L。已有研究报道以40 m AU/m L为PIVKA-Ⅱ的cut-off值,本研究根据PIVKA-Ⅱ是否≥40 m AU/m L将HCC组分为PIVKA-Ⅱ≥40组、PIVKA-Ⅱ<40组,对两组患者的性别、年龄、病毒载量、肿瘤分期、癌结节数目、肿块直径和是否抗病毒治疗进行比较,采用logistic回归分析两组患者的差异性指标,结果显示病毒载量[OR=1.150, 95%CI (1.022, 1.295), P=0.02]为PIVKA-Ⅱ检测肝癌的独立影响因素。相关分析表明PIVKA-Ⅱ与肝癌肿块直径呈正相关。此外, AFP、PIVKA-Ⅱ的cut-off值分组结果表明, PIVKA-Ⅱ≥32且AFP<20组的肝癌肿块直径大于PIVKA-Ⅱ<32且AFP≥20组(P=0.035)。因此, PIVKA-Ⅱ是优于AFP筛查肝细胞癌的血清学肿瘤标志物,其表达量与肿瘤肿块直径呈正相关。To explore the advantages of serum PIVKA-Ⅱ and AFP detection in the diagnosis of primary hepatocellular carcinoma (HCC), the levels of PIVKA-Ⅱ and AFP in sera of 237 patients were analyzed. The cohort included 115 patients with HBV-related primary HCC, 55 with asymptomatic carriers (AsC), 47 with liver cirrhosis (LC) and 20 with other cancers. The results showed that the levels of serum PIVKA-Ⅱ in HCC group were significantly higher than those in other groups (P<0.05). The sensitivities of AFP, PIVKA-Ⅱ and the two combined were 67.8%, 81.7% and 90.4%, respectively, in diagnosis of HCC, with the areas under the ROC curve being 0.881, 0.945 and 0.962, respectively. The cut-off value of PIVKA-Ⅱ was 32 mAU/mL in diagnosis of HCC. Then, the HCC patients were divided into two groups (the PIVKA-Ⅱ≥40 mAU/mL group and PIVKA-Ⅱ<40 mAU/mL group) based on many studies demonstrating that the cut-off of PIVKA-Ⅱ is 40 mAU/mL. The gender, age, hepatitis B viral load, tumor stage, number of cancer nodules, diameter of tumor mass and antiviral therapy were compared between the two groups. The results showed that hepatitis B viral load was an independent factor affecting the diagnosis of HCC by PIVKA-Ⅱ[OR=1.150, 95% CI (1.022, 1.295), P=0.02]. The level of serum PIVKA-Ⅱ was positively correlated with the diameter of HCC. In addition, the PIVKA-Ⅱ≥32 and AFP<20 group had a larger diameter of tumor mass than the PIVKA-Ⅱ<32 and AFP≥20 group (P=0.035). In conclusion, the serum PIVKA-Ⅱ is superior to the AFP in screening of HCC. The level of serum PIVKA-Ⅱ is positively correlated with the diameter of tumor mass.

关 键 词：原发性肝细胞癌 甲胎蛋白(AFP) 维生素K缺乏或拮抗剂Ⅱ诱导的蛋白质(PIVKA-Ⅱ) 诊断 影响因素 

分 类 号：R446.61[医药卫生—诊断学]