AFP、AFP-L3和PIVKA-Ⅱ在肝细胞癌临床评估中的应用价值  

The application value of serum AFP,AFP-L3 and PIVKA-Ⅱin clinical evaluation of hepatocellular carcinoma

作　　者：彭亚柏 程文兵[1] 朱秀云[1] 刘赛云[1] 王敏[1] 蔡侃儒[1] 张明霞[1] 刘甲野 PENG Ya-bai;CHENG Wen-bing;ZHU Xiu-yun;LIU Sai-yun;WANG Min;CAI Kan-ru;ZHANG Ming-xia;LIU Jia-ye(Institute of Hepatology,Shenzhen Third People's Hospital,Shenzhen,Guangdong 518112,China)

机构地区：[1]深圳市第三人民医院肝病研究所,广东深圳518112

出　　处：《热带医学杂志》2020年第7期920-923,927,F0004,共6页Journal of Tropical Medicine

基　　金：国家自然科学基金(81803299)。

摘　　要：目的探讨甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和异常凝血酶原(PIVKA-Ⅱ)在肝细胞癌(HCC)诊断中的应用价值。方法纳入2018年8月至2019年2月在深圳市第三人民医院确诊的330例肝病患者,其中包括110例慢性乙肝患者、110例肝硬化患者和110例肝细胞癌患者,采集患者血清,应用化学发光微粒子免疫检测法测定AFP和PIVKA-Ⅱ水平;用亲和吸附离心柱法分离血清AFP-L3,再用化学发光微粒子免疫检测法测定AFP-L3水平。结果肝细胞癌组患者AFP、AFP-L3及PIVKA-Ⅱ表达水平显著高于慢性乙肝组(P<0.0001)和肝硬化组(P<0.0001)。单独诊断HCC时,ROC分析显示,AFP、AFP-L3和PIVKA-Ⅱ的AUC分别为0.913(0.871~0.946)、0.881(0.834~0.928)、0.850(0.796~0.905),AFP诊断性能最佳。当AFP临界值为11.81 ng/mL时,诊断肝癌的灵敏度为88.18%,特异性为80.91%;当AFP-L3比值临界值为1.215 ng/mL时,灵敏度为84.55%,特异性为89.09%;当PIVKA-Ⅱ临界值为51.81 mAU/mL时,灵敏度为73.64%,特异性为94.55%。联合检测诊断HCC时,联合指标检测同时阳性的特异性比单指标检测肝癌的特异性提高,联合检测任一阳性时的灵敏度比单指标检测肝癌的灵敏度提高。大部分组合间的AUC增加至0.95以上。结论PIVKA-II、AFP-L3、AFP是诊断HCC的有效生物标志物。与单独分子检测诊断HCC相比,其组合大部分可以提高诊断性能。Objective To explore the application value of alpha-fetoprotein(AFP),alpha-fetoprotein-L3(AFP-L3),AFP/AFP-L3 and prothrombin induced by vitamin K absence II(PIVKA-II)in clinical evaluation of hepatocellular carcinoma(HCC).Methods A total of 330 patients,including 110 patients with chronic hepatitis B(CHB),110 patients with liver cirrhosis and 110 patients with HCC confirmed in Shenzhen Third Peoples Hospital from August 2018 to February 2019 were enrolled in this study.The chemiluminescence microparticle immunoassay method was used to detect the AFP and PIVKA-Ⅱcontent in the patients serum;the serum AFP-L3 was separated by the affinity adsorption spin column method,and then the AFP-L3 content was detected by chemiluminescent microparticle immunoassay.Results The expression levels of AFP,AFP-L3 and PIVKA-Ⅱin hepatocellular carcinoma were significantly higher than those in the chronic hepatitis B group(P<0.0001)and the cirrhosis group(P<0.0001).ROC analysis showed that the AUC of AFP,AFP-L3,and PIVKA-Ⅱwere 0.913(0.871-0.946),0.881(0.834-0.928),and 0.850(0.796-0.905),respectively.AFP had the best diagnostic performance when it was used to diagnose HCC alone.When AFP had a cut-off value of 11.81 ng/mL,the sensitivity for diagnosis of HCC was 88.18%and the specificity was 80.91%.When AFP-L3 had a cut-off value of 1.215 ng/mL,the sensitivity was 84.55%and the specificity was 89.09%,and when the PIVKA-II had a cut-off value of 51.81 mAU/mL,the sensitivity was 73.64%and specificity was 94.55%.When combined detection was used to diagnose HCC,the specificity and sensitivity of all"and"combinations was higher than that of single index detection of liver cancer.The AUC of most of different combinations increased above 0.95.Conclusions PIVKA-II,AFP-L3,and AFP were effective biomarkers for the diagnosis of HCC.Compared with the individual detection and diagnosis of HCC,their combination could mostly improve the diagnostic performance.

关 键 词：甲胎蛋白 甲胎蛋白异质体 异常凝血酶原 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]