血清AFP和PIVKA-Ⅱ的检测对肝炎病毒相关肝细胞癌的诊断价值  

The Diagnostic Value of Serum AFP and PIVKA-ⅡDetection in Hepatitis Virus-Related Hepatocellular Carcinoma

作　　者：方茜 李韦杰 郭晶晶[1] 方伟[1] 徐新民[1] 王雅杰 FANG Qian;LI Weijie;GUO Jingjing;FANG Wei;XU Xinmin;WANG Yajie(Department of Clinical Laboratory,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院检验科,北京100015

出　　处：《标记免疫分析与临床》2022年第9期1441-1445,共5页Labeled Immunoassays and Clinical Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金(乙肝五项定量测定临床价值探讨)(编号:320.6750.19089-75)。

摘　　要：目的探讨患者血清中甲胎蛋白(AFP)和异常凝血酶原(PIVKA-Ⅱ)的水平对乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)感染所致的肝细胞癌(HCC)的诊断价值。方法分析2021年7月至2022年1月在首都医科大学附属北京地坛医院就诊的HBV和HCV相关肝病患者共1051例,将其分为5组,分别是乙肝肝细胞癌组449例、乙肝肝硬化组126例、慢性乙型病毒性肝炎组406例、丙肝肝病组24例、丙肝肝细胞癌组46例,检测血清AFP和PIVKA-Ⅱ的水平进行统计分析。结果乙肝肝细胞癌组AFP和PIVKA-Ⅱ显著高于乙肝肝硬化组、慢乙肝组;丙肝肝细胞癌组AFP和PIVKA-Ⅱ显著高于丙肝肝病组,差异有统计学意义(P<0.01)。乙肝肝细胞癌患者单独检测AFP、单独检测PIVKA-Ⅱ、联合检测AFP和PIVKA-Ⅱ受试者工作曲线下面积分别是0.729、0.765和0.835,丙肝肝细胞癌患者单独检测AFP、单独检测PIVKA-Ⅱ、联合检测AFP和PIVKA-Ⅱ受试者工作曲线下面积分别是0.818、0.744和0.881,联合检测的诊断价值优于单独检测。结论PIVKA-Ⅱ单独诊断乙肝相关肝细胞癌时的灵敏度和特异性高于AFP,本文结果提示AFP诊断丙肝相关肝细胞癌的特异性高。AFP和PIVKA-Ⅱ的联合检测提高HCC诊断效能。Objective To explore the diagnostic value of serum alpha-fetoprotein(AFP)and abnormal prothrombin(PIVKA-Ⅱ)in patients with hepatocellular carcinoma(HCC)caused by hepatitis B virus and hepatitis C virus.Methods A total of 1051 patients with HBV and HCV-related liver diseases who were treated in Beijing Ditan Hospital affiliated to Capital Medical University from July,2021 to January,2022 were analyzed.These patients were divided into five groups:449 cases with hepatitis B hepatocellular carcinoma,126 cases with hepatitis B cirrhosis,406 cases with chronic hepatitis B,24 cases with hepatitis C hepatitis disease,and 46 cases with hepatitis C hepatocellular carcinoma.Serum AFP and PIVKA-Ⅱof each group of patients were statistically analyzed.Results Serum AFP and PIVKA-Ⅱin the hepatitis B hepatocellular carcinoma group were higher than those in the hepatitis B cirrhosis group and chronic hepatitis group.Serum AFP and PIVKA-Ⅱin the hepatitis C hepatocellular carcinoma group were higher than those in the hepatitis C hepatitis disease(P<0.01).ROC curve analysis showed results as following:for hepatitis B hepatocellular carcinoma,the area under the receiver operating curve of AFP was 0.729;the area under the receiver operating curve of PIVKA-Ⅱwas 0.765;the area under the receiver operating curve of the combined detection of AFP and PIVKA-Ⅱwas 0.835.For hepatitis C hepatocellular carcinoma,the area under the receiver operating curve of AFP was 0.818;the area under the receiver operating curve of PIVKA-Ⅱwas 0.744;the area under the receiver operating curve of the combined detection of AFP and PIVKA-Ⅱwas 0.881.The diagnostic value of combined tests was better than that of individual tests.Conclusion The sensitivity and specificity of PIVKA-II in diagnosing hepatitis B-related hepatocellular carcinoma are higher than that of AFP.The results of this study suggest that AFP has a higher specificity in diagnosing hepatitis C-related hepatocellular carcinoma.The combined detection of AFP and PIVKA-Ⅱcan improve th

关 键 词：肝细胞癌 甲胎蛋白 异常凝血酶原 乙型肝炎病毒 丙型肝炎病毒 

分 类 号：R735.7[医药卫生—肿瘤]