慢性乙型肝炎、乙型肝炎肝硬化和原发性肝癌患者血清腺苷脱氨酶、α-L-岩藻糖苷酶和AFP-L3水平变化及其临床意义探讨  

Implications of serum adenosine deaminase,α-L-fucosidase and alpha fetoprotein-L3 levels in patients with chronic hepatitis B,liver cirrhosis and primary liver cancer

作　　者：刘莹[1] 陈东妙 王从容[1] Liu Ying;Chen Dongmiao;Wang Congrong(Clinical Laboratory,Zengcheng Branch,Nanfang Hospital,Affiliated to Southern Medical University,Guangzhou 510000,Guangdong Province,China)

机构地区：[1]南方医科大学南方医院增城分院医学检验科,广州市510000

出　　处：《实用肝脏病杂志》2023年第4期552-555,共4页Journal of Practical Hepatology

基　　金：广东省科学技术厅科研项目[编号:粤科规财字(2017)103]。

摘　　要：目的探讨慢性乙型肝炎(CHB)、乙型肝炎肝硬化(LC)和乙型肝炎相关性原发性肝癌(PLC)患者血清腺苷脱氨酶(ADA)、α-L-岩藻糖苷酶(AFU)和甲胎蛋白-L3(AFP-L3)水平变化及其临床意义。方法2020年1月~2022年4月我院诊治的CHB患者76例、LC患者31例和乙型肝炎相关性PLC患者29例,采用酶比色法检测血清ADA水平,采用速率法检测血清AFU水平,采用ELISA检测血清AFP-L3水平。对CHB患者常规行肝活检术。应用受试者工作特征曲线(ROC)分析血清指标诊断PLC的效能。结果46例G2~G4的CHB患者血清ADA、AFU和AFP-L3水平分别为(29.6±5.1)μ/L、(34.7±5.0)μ/L和(6.9±1.2)%,显著高于30例G0/G1的CHB患者【分别为(25.4±3.9)μ/L、(29.5±5.2)μ/L和(5.8±0.8)%,P<0.05】,55例S2~S4的CHB患者血清ADA、AFU和AFP-L3水平分别为(43.8±10.1)μ/L、(66.5±18.8)μ/L和(8.3±1.3)%,显著高于21例S0/S1的CHB患者【分别为(28.1±6.0)μ/L、(33.0±8.4)μ/L和(6.4±1.1)%,P<0.05】;PLC患者血清ADA、AFU和AFP-L3水平分别为(51.3±5.2)μ/L、(82.0±9.5)μ/L和(9.2±1.3)%,显著高于LC患者【分别为(38.1±4.6)μ/L、(51.8±5.1)μ/L和(7.8±1.1)%,P<0.05】或CHB患者【分别为(26.5±4.6)μ/L、(30.9±5.6)μ/L和(6.1±0.8)%,P<0.05】;分别以血清AFP-L3=7.9%、AFU=55.1μ/L和ADA=46.0μ/L为截断点,AFP-L3诊断PLC的AUC为0.857,其灵敏度为86.2%,特异度为88.8%,显著优于AFU(分别为0.752、79.3%和77.6%)或ADA(分别为0.722、75.8%和76.6%,P<0.05)。结论应用血清AFP-L3水平诊断乙型肝炎患者罹患PLC的效能显著高于血清ADA或AFU水平,值得临床进一步验证。Objective The aim of this study was to investigate the implications of serum adenosine deaminase(ADA),α-L-fucosidase(AFU)and alpha fetoprotein-L3 levels in patients with chronic hepatitis B(CHB),liver cirrhosis(LC)and primary liver cancer(PLC).Methods 76 patients with CHB,31 patients with LC and 29 patients with hepatitis B-associated PLC were encountered in our hospital between January 2020 and April 2022,and serum ADA level was detected by enzymatic colorimetry.Serum AFU level was assayed by special kits and serum AFP-L3 level was determined by enzyme linked immunosorbent assay.The liver biopsies were performed in all patients with CHB.The diagnostic performance was evaluated by the area under the receiver operating characteristic curve(AUC).Results Based on the liver histopathologic examination in patients with CHB,the G0,G1,G2,G3 and G4 were found in(12 cases,18 cases,26 cases,16 cases and 4 cases,and the S0,S1,S2,S3 and S4 were found in 14 cases,7 cases,14 cases,20 cases and 21 cases;serum ADA,AFU and AFP-L3 levels in 46 patients with G2-G4 CHB were(29.6±5.1)μ/L,(34.7±5.0)μ/L and(6.9±1.2)%,all significantly higher than[(25.4±3.9)μ/L,(29.5±5.2)μ/L and(5.8±0.8)%,respectively,P<0.05]in 30 patients with G0/G1 CHB,and serum ADA,AFU and AFP-L3 levels in 55 patients with S2-S4 CHB were(43.8±10.1)μ/L,(66.5±18.8)μ/L and(8.3±1.3)%,significantly higher than(28.1±6.0)μ/L,(33.0±8.4)μ/L and(6.4±1.1)%,P<0.05]in 21 patients with S0/S1 CHB;serum ADA,AFU and AFP-L3 levels in patients with PLC were(51.3±5.2)μ/L,(82.0±9.5)μ/L and(9.2±1.3)%,significantly higher than[(38.1±4.6)μ/L,(51.8±5.1)μ/L and(7.8±1.1)%,respectively,P<0.05]in patients with LC or[(26.5±4.6)μ/L,(30.9±5.6)μ/L and(6.1±0.8)%,respectively,P<0.05]in patients with CHB;the AUCs determined by serum AFP-L3 level were 0.857,with the sensitivity(Se)of 86.2%and the specificity of 88.8%,much superior to that by AFU(0.752,79.3%and 77.6%,respectively)or that by ADA(0.722,75.8%and 76.6%,respectively,P<0.05),when serum AFP-L3=7.9%,serum AFU=

关 键 词：原发性肝癌 肝硬化 慢性乙型肝炎 腺苷脱氨酶 Α-L-岩藻糖苷酶 甲胎蛋白-L3 诊断 

分 类 号：R735.7[医药卫生—肿瘤] R512.62[医药卫生—临床医学] R575.2