血清PIVKA-Ⅱ、TK1和AFP联合检测在肝细胞癌诊断中的价值  

The value of combined detection of serum PIVKA-Ⅱ,TK1 and AFP in the diagnosis of hepatocellular carcinoma

作　　者：薄维波 李海英 安仲武 冯小娟 王波 闫朝春 朱洪波 郭加友 BO Weibo;LI Haiying;AN Zhongwu;FENG Xiaojuan;WANG Bo;YAN Chaochun;ZHU Hongbo;GUO Jiayou(Department of Clinical Laboratory,the Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University,Lianyungang,Jiangsu 222042,China;Department of General Surgery,the Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University,Lianyungang,Jiangsu 222042,China;Department of Oncology,the Affiliated Lianyungang Oriental Hospital of Kangda College of Nanjing Medical University,Lianyungang,Jiangsu 222042,China)

机构地区：[1]南京医科大学康达学院附属连云港市东方医院检验科,江苏连云港222042 [2]南京医科大学康达学院附属连云港市东方医院普外科,江苏连云港222042 [3]南京医科大学康达学院附属连云港市东方医院肿瘤科,江苏连云港222042

出　　处：《国际检验医学杂志》2021年第11期1317-1321,共5页International Journal of Laboratory Medicine

基　　金：江苏省连云港市卫生科技项目(201927)。

摘　　要：目的探讨血清异常凝血酶原复合物(PIVKA-Ⅱ)、细胞质胸苷激酶1(TK1)和甲胎蛋白(AFP)联合检测在肝细胞癌(HCC)中的诊断价值。方法选择2018年1月至2019年12月在连云港市东方医院住院的61例HCC患者为HCC组、50例肝硬化(LC)患者为LC组、58例慢性肝炎(CH)患者为CH组,另选择60例体检健康者作为对照组。采用化学发光法检测血清PIVKA-Ⅱ和AFP水平,免疫印迹增强化学发光法检测血清TK1水平。采用二分类变量Logistic回归进行分析,产生新变量(预测概率),并采用受试者工作特征(ROC)曲线分析各指标,评估PIVKA-Ⅱ、AFP、TK1单项及联合检测诊断HCC的ROC曲线下面积(AUC)、灵敏度及特异度。结果HCC组、LC组、CH组及对照组血清PIVKA-Ⅱ、TK1和AFP水平比较,差异均有统计学意义(P<0.05)。单独检测诊断HCC时,PIVKA-Ⅱ的灵敏度(86.89%)和TK1特异度(86.62%)最高;2项联合检测诊断HCC时,AFP/TK1并联检测(其中一项阳性即为阳性)的灵敏度(91.80%)和AFP+PIVKA-Ⅱ串联检测(2项均阳性才为阳性)的特异度(95.88%)最高;3项联合检测诊断HCC时,AFP/TK1/PIVKA-Ⅱ并联检测的灵敏度(95.08%)和AFP+TK1+PIVKA-Ⅱ串联检测的特异度(96.29%)较高。PIVKA-Ⅱ、TK1、AFP单独检测诊断HCC的最佳临界值分别为35.88 mAU/mL、2.15 pmol/L和11.70 ng/mL,3项联合检测诊断HCC的AUC[0.928(95%CI:0.799~0.952)]高于PIVKA-Ⅱ、TK1、AFP单独检测诊断HCC的AUC[0.839(95%CI:0.753~0.886)、0.801(95%CI:0.720~0.843)、0.708(95%CI:0.549~0.740)],差异均有统计学意义(P<0.05)。在AFP阴性的HCC患者中,PIVKA-Ⅱ和TK1联合检测的灵敏度(92.31%)高于二者单独检测的灵敏度(80.77%、57.69%),差异均有统计学意义(P<0.05)。结论PIVKA-Ⅱ、TK1和AFP联合检测可明显提高HCC的早期诊断率,能有效地避免一些AFP阴性的HCC病例的漏检。Objective To investigate the value of combination detection of serum protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)、cytoplasmic thymidine kinase 1(TK1)and alpha-fetoprotein(AFP)in diagnosis of hepatocellular carcinoma(HCC).Methods From January 2018 to December 2019,61 HCC patients who were hospitalized in Lianyungang Oriental Hospital were selected as the HCC group,50 patients with liver cirrhosis(LC)as the LC group,58 patients with chronic hepatitis(CH)as the CH group,and 60 healthy persons on physical examination were selected as the control group.The serum levels of PIVKA-Ⅱand AFP were detected by electrochemiluminescence immunoassay,and the serum level of TK1 were detected by Western blot-enhanced chemiluminescence.A binary Logistic regression analysis was used to obtain the new variable of predicted probability,and the receiver operating characteristic(ROC)curve was used to analyze each indicator and to evaluate the area under the ROC curve(AUC),sensitivity and specificity of the three indicators used alone or combination detection in the diagnosis of HCC.Results The differences were statistically significant in levels of serum PIVKA-Ⅱ,TK1 and AFP among the HCC group,the LC group,the CH group and the control group(P<0.05).When HCC was diagnosed by single detection,the sensitivity of PIVKA-Ⅱ(86.89%)and the specificity of TK1(86.62%)were the highest;When any two of these indicators were combined detection,the sensitivity(91.80%)of AFP/TK1 parallel detection and specificity(95.88%)of AFP+PIVKA-Ⅱtandem detection were the highest in the diagnosis of HCC;In the diagnosis of HCC by combined detection of the three indicators,the sensitivity of AFP/TK1/PIVKA-Ⅱparallel detection(95.08%)and the specificity of AFP+TK1+PIVKA-Ⅱserial detection(96.29%)were higher.The best cut-off values of PIVKA-Ⅱ,TK1,and AFP for the diagnosis of HCC were 35.88 mAU/mL,2.15 pmol/L and 11.70 ng/mL,respectively.The AUC[0.928(95%CI:0.799-0.952)]of the three indicators combined detection for the diagnosis of H

关 键 词：肝细胞癌 异常凝血酶原复合物 细胞质胸苷激酶l 甲胎蛋白 诊断 

分 类 号：R735.7[医药卫生—肿瘤]