ASAP模型在肝细胞癌筛查中的诊断价值研究  

Research on the screening and diagnosis value of hepatocellular carcinoma based on ASAP model

作　　者：张春平 刘玉庆 佘炜[2] ZHANG Chun-Ping;LIU Yu-qing;SHE Wei(The Center of Clinical Laboratory,Sichuan Great Master Diagnostics Co.Ltd,Chengdu 611731,China;Department of clinical Laboratory,Sichuan Academy of Medical Sciences&Sichuan Provincial People’s Hospital,Chengdu 610072,China)

机构地区：[1]四川大家医学检验中心,四川成都611731 [2]四川省医学科学院·四川省人民医院检验科,四川成都610072

出　　处：《实用医院临床杂志》2023年第5期79-83,共5页Practical Journal of Clinical Medicine

基　　金：四川省科技厅重点研发计划项目(编号:22ZDYF1640)。

摘　　要：目的 探讨基于年龄、性别、甲胎蛋白(AFP)和异常凝血酶原(PIVKA-Ⅱ)的ASAP模式在原发性肝癌(HCC)筛查和诊断中的应用价值。方法 2022年1月至2023年2月四川省人民医院门诊及住院患者和健康体检者共716例,分为肝细胞癌组(HCC组)、肝硬化组、肝炎组及健康对照组,检测受检者血清AFP和PIVKA-Ⅱ水平,并计算ASAP,采用受试者工作特性曲线(ROC)计算各指标单独或联合检测对HCC诊断的敏感度、特异度和约登指数,评价不同检测模式对HCC的筛查和诊断效能。结果 HCC组AFP、PIVKA-Ⅱ及ASAP水平高于肝硬化组、肝炎组和健康对照组(P<0.01)。以生物参考区间作为HCC阳性截断值,评价不同指标的诊断效能,ASAP阳性模式的敏感度最高,达到88.3%,而其特异度最低,为60.8%。纳入HCC组和其他非肝癌组作为测试队列,ASAP和PIVKA-Ⅱ的敏感度和曲线下面积(AUC)基本一致,均优于AFP,但ASAP模式的特异度和约登指数优于PIVKA-Ⅱ。而HCC组和健康对照组作为测试队列,其ASAP模式的AUC最大,优于AFP和PIVKA-Ⅱ;ASAP模式和PIVKA-Ⅱ的敏感度基本一致,但ASAP模式的特异度和约登指数优于PIVKA-Ⅱ。结论 ASAP模式对HCC的诊断效能优于血清肿瘤标志物单项或联合检测,适合于人群HCC的筛查和诊断。针对肝脏疾病患者和体检健康人群,AFP、PIVKA-Ⅱ和ASAP使用不同的截断值,可以显著提高HCC筛查和诊断的敏感度和特异度。Objective To evaluate the application value of ASAP based on age,sex,alpha-fetoprotein(AFP)and protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)in screening and diagnosis of hepatocellular carcinoma(HCC).From January 2022 to February 2023,a total of 716 outpatients,inpatients and health controls were recruited in the Sichuan Provincial People′s Hospital.The patients were divided into a HCC group,a liver cirrhosis group,a chronic hepatitis B group and a healthy control group.The serum AFP and PIVKA-Ⅱlevels were detected and the ASAP were calculated.The sensitivity,specificity and Youden′s index were calculated by using receiver operating characteristic curve(ROC)analysis to evaluate the effectiveness of different detection modes in the screening and diagnosis of HCC.The levels of AFP,PIVKA-Ⅱand ASAP in the HCC group were significantly higher than those in the liver cirrhosis group,the chronic hepatitis B group and the healthy control group(P<0.01).The diagnostic efficiency of different indexes was calculated by using the biological reference interval as the positive cutoff value of HCC.The ASAP positive pattern had the highest sensitivity(88.3%)and the lowest specificity(60.8%).HCC group and all non-HCC groups were included as test cohort.The sensitivity and area under the curve(AUC)of ASAP and PIVKA-Ⅱwere basically the same,which both were superior to AFP.However,the specificity and Youden′s index of ASAP model were better than PIVKA-Ⅱ.The HCC group and the healthy control group were used as test cohort.The AUC of ASAP was the largest,which was superior to that of AFP and PIVKA-Ⅱalone.The sensitivity of ASAP and PIVKA-Ⅱwas similar,but the specificity and Youden′s index of ASAP model were better than that of PIVKA-Ⅱ.The diagnostic efficacy of ASAP is better than that of single or combined detection of serum tumor markers.The use of different cutoff values for AFP,PIVKA-II and ASAP in patients with liver disease and in healthy individuals can significantly improve the sensitivi

关 键 词：原发性肝细胞癌 维生素K缺乏或拮抗剂诱导的蛋白质 甲胎蛋白 诊断 筛查 

分 类 号：R593.22[医药卫生—内科学]