血清PIVKA-Ⅱ、AFP和GGT对原发性肝癌的诊断价值  

The Diagnostic Value of Serum PIVKA-Ⅱ, AFP and GGT in Primary Liver Cancer

作　　者：李敏[1] 刘检[1] 周怡[1] 孙青[1] 郑晓[1] 蒋敬庭[1] 陆明洋[1] LI Min;LIU Jian;ZHOU Yi;SUN Qing;ZHENG Xiao;JIANG Jingting;LU Mingyang(Department of Tumor Biological Treatment, the Third Affiliated Hospital of Soochow University, Changzhou 213003, China)

机构地区：[1]苏州大学附属第三医院肿瘤生物诊疗中心,江苏常州213003

出　　处：《标记免疫分析与临床》2021年第10期1759-1764,1769,共7页Labeled Immunoassays and Clinical Medicine

基　　金：国家自然科学基金(编号:81972869);江苏省肿瘤免疫治疗工程技术研究中心(编号:BM2014404);常州市卫健委青年人才(编号:QN202014);常州市卫生青苗人才(编号:CZQM2020052)。

摘　　要：目的通过检测血清肿瘤标志物PIVKA-Ⅱ、AFP和GGT的水平,探讨这3个检测项目在原发性肝癌中的诊断价值,进而为原发性肝癌的早期诊断提供有力的依据。方法研究对象为已证实患原发性肝癌(PHC)的住院患者,对照为健康体检人员与患肝良性疾病患者。分别测定血清PIVKA-Ⅱ、AFP和GGT水平,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),明确最佳临界值(cut-off value),评价3项指标对原发性肝癌的诊断价值。结果血清PIVKA-Ⅱ、AFP和GGT水平在原发性肝癌与肝胆良性疾病和健康体检者比较时,3项指标的差异均具有统计学意义(P<0.01)。3项指标用于诊断原发性肝癌绘制的ROC曲线,AUC_(PIVKA-Ⅱ)=0.882,AUC_(AFP)=0.833,AUC_(GGT)=0.703,可见,在诊断PHC方面,单项指标中PIVKA-Ⅱ具备最高的诊断价值,其次为AFP,诊断价值最低的为GGT。分析PIVKA-Ⅱ、AFP与GGT血清水平对PHC的诊断效率,灵敏度PIVKA-Ⅱ最高为73.0%(AFP:55.7%,GGT:47.8%),特异性AFP最高为97.9%(PIVKA-Ⅱ:96.5%,GGT:73.4%),阳性预测值AFP最高为95.5%(PIVKA-Ⅱ:94.4%,GGT:59.1%),阴性预测值PIVKA-Ⅱ最高为81.7%(AFP:73.3%,GGT:63.6%),准确性PIVKA-Ⅱ最高为86.0%(AFP:79.1%,GGT:62.0%)。当3项指标联合检测时,特异性和阳性预测值略有下降,而灵敏度上升到80.9%(单项检测最高的PIVKA-Ⅱ为73.0%),阴性预测值上升到86.0%(单项检测最高的PIVKA-Ⅱ为81.7%),准确性上升到88.4%(单项检测最高的PIVKA-Ⅱ为86.0%)。结论单项指标中PIVKA-Ⅱ有较好的灵敏度和准确性,AFP具有较好的特异性,而AFP和GGT水平对于PIVKA-Ⅱ阴性的原发性肝癌的诊断具有较好的补充作用。因此,3项指标联合测定,能够使PHC的诊断准确性与灵敏度提升。Objective To explore the diagnostic value of PIVKA-Ⅱ, AFP and GGT in primary liver cancer by detecting the levels of serum tumor markers, so as to provide a strong reference basis for the early diagnosis of primary liver cancer.Methods Hospitalized patients diagnosed with primary liver cancer were selected as the research objects, while patients with benign liver diseases and healthy people were selected as the control group. Serum levels of PIVKA-Ⅱ, AFP and GGT were measured, receiver operating characteristic curve(ROC) was drawn, and the cut-off value was determined to evaluate the diagnostic value of these three indicators for primary liver cancer.Results Levels of PIVKA-Ⅱ, AFP and GGT in patients with primary liver cancer were significantly different from those with benign hepatobiliary diseases and healthy controls(P<0.01). ROC analysis showed that: AUC_(PIVKA-II)=0.882, AUC_(AFP)=0.833, and AUC_(GGT)=0.703, which indicated that PIVKA-Ⅱ had the highest diagnostic value for primary liver cancer, while AFP was slightly lower than PIVKA-Ⅱ, and GGT had the lowest diagnostic value. Sensitivity of PIVKA-Ⅱ was 73.0%(AFP:55.7%, GGT:47.8%), specificity of AFP was 97.9%(PIVKA-Ⅱ:96.5%, GGT:73.4%). Positive predictive value of AFP was 95.5%(PIVKA-Ⅱ:94.4%, GGT:59.1%), and negative predictive value of PIVKA-Ⅱ was 81.7%(AFP:73.3%, GGT:63.6%). Accuracy of PIVKA-Ⅱ was 86.0%(AFP:79.1%, GGT: 62.0%). When these three indicators were detected together, specificity and positive predictive value decreased slightly, while sensitivity increased to 80.9%(the highest single test was PIVKA-Ⅱ, the result was 73.0%), negative predictive value increased to 86.0%(the highest single test was PIVKA-Ⅱ, the result was 87.1%), and accuracy increased to 88.4%(the highest single test was PIVKA-Ⅱ, the result was 86.0%).Conclusion Our results showed that PIVKA-Ⅱ has a better sensitivity and accuracy, while AFP has a better specificity, and the levels of AFP and GGT have a better complementary role in the diagnosis of PIV

关 键 词：原发性肝癌 异常凝血酶原 甲胎蛋白 谷氨酰转肽酶 肿瘤标志物 

分 类 号：R735.7[医药卫生—肿瘤]