甲胎蛋白、α-L-岩藻糖苷酶、糖链抗原125血清检测在原发性肝癌筛查及鉴别诊断中的价值  

To explore the value of serum AFP,AFU and CA125 in the screening and differential diagnosis of primary liver cancer

作　　者：胡广梅[1] 钟日辉[1] 黄利思[1] 陈新亮 欧阳佩雯 段朝晖[1] HU Guang-mei;ZHONG Ri-hui;HUANG Li-si;CHEN Xin-liang;OUYANG Pei-wen;DUAN Zhao-hui(Clinical Laboratory,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510120,China;不详)

机构地区：[1]中山大学孙逸仙纪念医院检验科,广东广州510120 [2]广州医科大学,广东广州510182

出　　处：《中国卫生检验杂志》2020年第17期2052-2055,共4页Chinese Journal of Health Laboratory Technology

基　　金：广东省自然科学基金(2014A030313070)。

摘　　要：目的探讨AFP、AFU、CA125单独以及联合检测对原发性肝癌筛查及鉴别诊断的临床价值。方法原发性肝癌(PHC)125例、非PHC肝病105例、健康体检者90例纳入研究。分别测定各组对象的血清AFP、AFU、CA125水平并对结果进行统计学分析。结果PHC组3种标志物血清浓度显著高于其他组,差异有统计学意义(P<0.05)。单测AFP筛查时,灵敏度仅68.8%,漏诊率高,当串联联合AFU检测时灵敏度可提升至81.6%。ROC曲线分析发现,AFP+AFU串联检测的AUC最大,与三项指标串联联合筛查效能等同。与非PHC肝病鉴别诊断时,单测AFP时AUC最大(0.87)。另外,Ⅰ/Ⅱ期PHC患者中3种标志物的血清浓度与阳性率皆显著低于Ⅲ/Ⅳ期患者。结论筛查PHC时,推荐串联AFP+AFU检测模式,可显著减少漏诊。鉴别诊断时,仅单测AFP即可。3种指标皆表现出与疾病严重程度良好相关,后期可进一步探索。Objective To investigate the clinical value of screening and differential diagnosis of primary liver cancer with serum AFP,AFU,CA125 alone and in combination.Methods A total of 125 cases of primary liver cancer(PHC),105 cases of non-PHC liver disease,90 cases of healthy physical examination were enrolled into the study.The serum levels of AFP,AFU and CA125 in each group were measured and the results were statistically analyzed.Results The three serum markers in PHC group were significantly higher than those in the control group,and the difference was statistically significant(P<0.05).For screening diagnosis,the sensitivity of AFP alone is only 68.8%.While,if combined with AFU,the sensitivity can be significantly improved(81.6%).ROC curve analysis showed that the AUC of APF+AFU tandem detection would be maximal,which was equivalent to the three indicators in tandem combined screening.When distinguishing from non-PHC liver disease,single-detecting AFP can obtain the outstanding differential diagnosis efficiency(AUC=0.87).In addition,the serum concentrations and positive rates of the three markers in PHC patients with stageⅠ/Ⅱwere significantly lower than those in stageⅢ/Ⅳof PHC.Conclusion When screening diagnosis of PHC,the serial AFP+AFU detection mode is recommended,which can significantly reduce missed diagnosis.For differential diagnosis,AFP can be measured alone.All three indicators showed a good correlation with the severity of the disease,which can be further explored later.

关 键 词：原发性肝癌 联合诊断 筛查 鉴别诊断 

分 类 号：R735.7[医药卫生—肿瘤]