血清异常凝血酶原在肝细胞肝癌临床应用中的价值  

The value of serum abnormal prothrombin in clinical application of hepatocellular carcinoma

作　　者：张珈玮 关连越[1] 鄂长勇[1] 杨景慧[1] 宣巍[1] 孟子辉[1] 李巍[1] Zhang Jiawei;Guan Lianyue;E Changyong;Yang Jinghui;Xuan Wei;Meng Zihui;Li Wei(Department of Hepatobiliary-Pancreatic Surgery,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院肝胆胰外科,长春130033

出　　处：《中华外科杂志》2020年第10期776-781,共6页Chinese Journal of Surgery

基　　金：国家自然科学基金(81273264);吉林省自然科学基金(20190201227JC);吉林省发改委创新能力建设基金(2019C015)。

摘　　要：目的探讨血清异常凝血酶原(PIVKA-Ⅱ)检测在肝细胞肝癌(HCC)早期诊断和监测中的价值。方法回顾性分析2017年10月至2018年5月吉林大学中日联谊医院肝胆胰外科收治的215例HCC患者的临床资料。男性172例,女性43例,年龄(59.0±9.3)岁(范围:34~86岁)。另纳入同期收治的85例非HCC患者作为对照组,男性42例,女性43例,年龄(54.2±11.3)岁(范围:22~80岁)。患者入院后第2天清晨6时,采用真空采血管,空腹采肘静脉血约3 ml,避光低温保存,当日送检。取甲胎蛋白(AFP)≥20μg/L为阳性,PIVKA-Ⅱ≥32 AU/L为阳性。数据的比较采用χ^2检验、t检验或秩和检验。采用线性回归分析AFP和PIVKA-Ⅱ与肿瘤最大径的相关性。结果PIVKA-Ⅱ单独检测在HCC各期的灵敏度均高于或等于AFP,PIVKA-Ⅱ和AFP单独诊断HCC的总体灵敏度分别为85.1%和52.1%,但PIVKA-Ⅱ的特异度不及AFP高,分别为78.8%和96.5%。在HCC的早期(Ⅰa期),PIVKA-Ⅱ单独检测的灵敏度为64.5%,而AFP的灵敏度仅为26.3%。两者联合检测可提高HCC诊断的灵敏度至88.4%,特异度至76.5%。PIVKA-Ⅱ值与肿瘤最大径呈正相关(r^2=0.587,P<0.05),而AFP水平与肿瘤最大径无相关性(r^2=0.296,P>0.05),PIVKA-Ⅱ诊断伴有血管侵犯的HCC患者的阳性率亦高于AFP(P<0.01)。结论PIVKA-Ⅱ可作为HCC筛查和诊断的血清学标志物,在早期肝癌诊断的阳性率显著高于AFP。PIVKA-Ⅱ和AFP联合检测可有效提高HCC各期检出率。PIVKA-Ⅱ的大幅度增高有助于协助判断HCC的侵袭性、是否存在血管侵犯及预后等。Objective To examine the value of serum protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)detection in the early diagnosis and surveillance of hepatocellular carcinoma(HCC).Methods The clinical data of 215 patients with HCC admitted to Department of Hepatobiliary-Pancreatic Surgery of China-Japan Union Hospital of Jilin University from October 2017 to May 2018 were analyzed retrospectively.There were 172 males and 43 females,aged of(59.0±9.3)years old(range 34 to 86 years old).In addition,there were 85 non HCC patients were enrolled in the control group,42 males and 43 females,aged(54.2±11.3)years old(range 22 to 80 years old).The blood sample of 3 ml was drawn from the elbow vein at 6∶00 am on the next day of admission,and then was kept in low temperature away from light,and sent for PIVKA-Ⅱ detection on the same day.The positive value of AFP was ≥20μg/L and PIVKA-Ⅱ was≥32 AU/L.The data were analyzed statistically by χ^2 test,t test or rank sum test.The correlation between AFP,PIVKA-Ⅱ and tumor maximum diameter was analyzed by linear regression.Results The sensitivity of PIVKA-Ⅱ detection only for the diagnosis of HCC in all stages was significantly higher than AFP or equivalent to AFP,the overall sensitivity of PIVKA-Ⅱ and AFP was 85.1%and 52.1%,respectively.But the specificity of PIVKA-Ⅱ was lower than that of AFP,they were 78.8% and 96.5%,respectively.In particularly,in the earlier stage of HCC(Ⅰa),the sensitivity of PIVAK-Ⅱto HCC was 64.5%,while the AFP was only 26.3%.Combined detection of PIVKA-Ⅱ and AFP significantly improved the diagnostic rate of HCC to 88.4%,and the specificity to 76.5%.Moreover,there was a positive correlation between PIVKA-Ⅱ level and the maximum tumor diameter(r2=0.587,P<0.05),but there was no correlation between the AFP level and the maximum tumor diameter(r2=0.296,P>0.05).The positive rate of PIVKA-Ⅱ in the diagnosis of HCC with vascular invasion was also significantly higher than that of AFP(P<0.01).Conclusions PIVKA-Ⅱ can be used a

关 键 词：肝肿瘤 诊断 甲胎蛋白 pivKA-Ⅱ 灵敏度 特异度 

分 类 号：R735.7[医药卫生—肿瘤]