血清AFP、PIVKA-Ⅱ、miR-21检测对肝细胞癌的诊断意义  

Diagnostic significance of serum AFP, PIVKA-Ⅱ, and miR-21 in hepatocellular carcinoma

作　　者：周莉[1] 陈辰[1] 翟璐[1] 程晓静[1] 韩旭[1] 姚升娟[2] 高敏[1] 李嘉[1] Zhou Li;Chen Chen;Zhai Lu;Cheng Xiaojing;Han Xu;Yao Shengjuan;Gao Min;Li Jia(Department of Hepatology,Tianjin Second People’s Hospital,Tianjin Hepatopathy Institute,Tianjin 300192,China;Department of Radiology,Tianjin Second People's Hospital,Tianjin 300192,China)

机构地区：[1]天津市第二人民医院肝病科,天津市肝病医学研究所,天津300192 [2]天津市第二人民医院放射科,天津300192

出　　处：《实用器官移植电子杂志》2022年第2期135-139,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：天津市第二人民医院院所级科研基金项目(YS-0012)。

摘　　要：目的 探讨血清甲胎蛋白(alpha-fetoprotein,AFP)、异常凝血酶原(protein induced by vitamin K absence antagonist-Ⅱ,PIVKA-Ⅱ)和微小RNA-21(microRNA-21,miR-21)检测对肝细胞癌(hepatocellular carcinoma,HCC)的诊断意义。方法 筛选2017年12月至2018年6月在天津市第二人民医院住院的代偿期肝硬化患者,经肝脏钆塞酸二钠增强MRI检查,纳入临床诊断为HCC、肝硬化伴高度异型增生结节(high-grade dysplastic nodules,HGDN)及肝硬化伴再生结节(regenerativenodule,RN)的患者共90例,分为HCC组、HGDN组及RN组,每组30例。收集血清检测AFP、PIVKA-Ⅱ及miR-21水平。采用Kruskal-Wallis H检验比较组间差异,Bonferroni法校正显著性水平后进一步两两比较,通过二元logistic回归建立三种指标联合模型APR,采用受试者工作特征曲线下面积(the area under the receiver operating characteristic curve,AUC)评估AFP、PIVKA-Ⅱ、miR-21及联合模型APR对HCC的诊断效能。结果 AFP、PIVKA-Ⅱ水平在RN组和HGDN组间无差异,但HCC组高于HGDN组和RN组,差异有统计学意义(校正后P <0.05);miR-21水平在RN组、HGDN组及HCC组间逐渐升高,差异有统计学意义(校正后P <0.05)。单项检测诊断HCC时,AFP的特异度为91.7%,敏感度为53.3%;PIVKA-Ⅱ的特异度为93.3%,敏感度为66.7%;miR-21的敏感度为97.1%,特异度为85.0%。三种指标联合模型APR的敏感度和特异度分别为93.3%、91.7%。AFP、PIVKA-Ⅱ、miR-21及联合模型APR对HCC诊断的AUC分别为0.756、0.873、0.953和0.963。结论 血清AFP、PIVKA-Ⅱ、 miR-21对HCC有较高的诊断价值,但单项检测时各有不足,三者联合检测有助于HCC的诊断筛查。Objective To investigate the value of serum AFP, PIVKA-Ⅱ and miR-21 in hepatocellular carcinoma(HCC). Methods A total of 90 patients with compensatory cirrhosis who hospitalized in the Department of Hepatology, Tianjin Second People’s Hospital from December 2017 to June 2018 were enrolled.All patients underwent liver(gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid,Gd-EOB-DTPA) enhanced MRI. The patients were divided into three groups : HCC group, high-grade dysplastic nodules(HGDN)group and regenerative nodule(RN) group, and each group had 30 patients. Their serum samples were collected and the serum levels of PIVKA-Ⅱ, AFP and miR-21 were measured. Kruskal-wallis H test was used to compare the differences between groups. Significance levels were corrected by Bonferroni method and pairwise comparisons were made.The index of AFP, PIVKA-Ⅱ and miR-21 was analyzed by binary logistic regression, and the diagnostic value of the above indexes for HCC was evaluated by the areas under the receiver operating characteristic curve(AUC). Results There were no difference in AFP and PIVKA-Ⅱ level between RN and HGDN group. However, AFP and PIVKA-Ⅱ levels in HCC group were higher than those in the other two groups, and the difference was statistically significant(adjusted P < 0.05). The level of miR-21 increased gradually from the RN group, HGDN group to HCC group. There were significant differences in the serum levels of miR-21 among the three groups(adjusted P < 0.05). When measured alone, the specificity and sensitivity of AFP were 91.7% and 53.3% in the diagnosis of HCC. The specificity and sensitivity of PIVKA-Ⅱ were 93.3% and 66.7% and the sensitivity and specificity of miR-21 were 97.1% and 85.0%,respectively. The sensitivity and specificity of the combined model of APR were 93.3% and 91.7%. The AUC of AFP, PIVKA-Ⅱ, miR-21 and APR were 0.756、0.873、0.953 and 0.963,respectively. Among them, APR had the highest AUROCs. Conclusion Serum AFP, PIVKA-Ⅱ and mi R-21 have a high clinical value in the

关 键 词：原发性肝癌 甲胎蛋白 异常凝血酶原 微小RNA-21 高度异型增生结节 诊断 

分 类 号：R735.7[医药卫生—肿瘤]