HBV感染综合标志物特征性改变对HCC的诊断价值  

Diagnostic value of characteristic changes in comprehensive markers of HBV infection in HCC

作　　者：孙健 周芳媛 郭志义 SUN Jian;ZHOU Fangyuan;GUO Zhiyi(Department of Pathogenic Biology,School of Basic Medical Sciences,North China University of Science and Technology;Hebei Provincial Key Laboratory of Basic Medicine for Chronic Diseases,Tangshan 063200,China)

机构地区：[1]华北理工大学基础医学院河北省慢性疾病基础医学重点实验室,河北省唐山市063200 [2]华北理工大学附属医院检验科

出　　处：《中国煤炭工业医学杂志》2023年第4期346-351,共6页Chinese Journal of Coal Industry Medicine

基　　金：教育部留学回国人员科研启动基金(教外司留[2015]311号)。

摘　　要：目的 探讨HBV感染综合乙肝标志物(CHBM)特征性改变在提高肝细胞癌(HCC)早期诊断灵敏度中的作用。方法 选择2016年1月—2022年5月在华北理工大学附属医院确诊的患者为研究对象,共992例,其中慢性乙型肝炎组236例,肝硬化组202例,HCC组265例,健康对照组289例,分别检测四组中甲胎蛋白(AFP)、癌胚抗原(CEA)、糖类抗原199(CA199)、碱性磷酸酶(ALP)、γ-谷氨酰转移酶(GGT)、总胆汁酸(TBA)、乙型肝炎表面抗原(HBs Ag)、乙型肝炎e抗原(HBe Ag)、乙型肝炎e抗体(抗-HBe)、HBV DNA的水平及阳性率,寻找慢性乙型肝炎转归为HCC时综合乙肝标志物水平及阳性率变化趋势,并将此变化趋势视为“综合乙肝标志物阳性”。将此综合标志物与传统指标联合检测,对数据进行统计分析。结果 在合并HBV感染的HCC组中,血清HBs Ag滴度≤1000IU/ml者占61.82%,HBV DNA≤10000copies/ml者占61.41%,HBe Ag阳性者占20.33%,抗-HBe阳性者占67.22%。“AFP+GGT+综合乙肝标志物”和“AFP+CEA+综合乙肝标志物”两种新的联合检测模式的灵敏度和AUC值为别为89.1%、84.9%和0.930、0.940,显著高于AFP、CEA、CA199、ALP、GGT、TBA6项传统指标联合检测(81.9%和0.900)。结论 HBV感染综合乙肝标志物特征性改变作为HCC筛查的新指标与传统HCC筛查指标联合检测可在特异性损失较小的基础上显著提高HCC早期诊断灵敏度。Objective To investigate the role of characteristic changes in comprehensive markers of HBV infection in improving the sensitivity of early diagnosis of hepatocellular carcinoma(HCC). Methods A total of nine hundred and ninety two patients diagnosed in the Affiliated Hospital of North China University of Science and Technology from January 2016 to May 2022 were selected as the study subjects, including two hundred and thirty-six cases in chronic hepatitis B group, two hundred and two cases in liver cirrhosis group, two hundred and sixty five cases in HCC group and two hundred and eighty nine cases in healthy control group.The levels and positivity rates of Alpha-fetoprotein(AFP),Carcinoembryonic antigen(CEA),Carbohydrate antigen 199(CA199),Alkaline phosphatase(ALP),Total bile acids(TBA),γ-Glutamyltransferase(GGT),Hepatitis B surface antigen(HBsAg),Hepatitis B e antigen(HBeAg),anti-HBe and HBV DNA were detected in the four groups, and the trend of comprehensive hepatitis B marker level and positivity rate when chronic hepatitis B was converted to HCC was sought, and this trend was regarded as "comprehensive hepatitis B marker positive".This comprehensive marker was combined with traditional indicators to analyze the data. Results In the HCC group with HBV infection, 61.82% had serum HBsAg titer ≤ 1 000IU/ml, HBV DNA ≤ 10 000 copies/ml accounted for 61.41%,HBeAg positive accounted for 20.33%,and anti-HBe positive accounted for 67.22%.The sensitivity and AUC values of the two new combined detection modes of "AFP+GGT+Comprehensive Hepatitis B Marker" and "AFP+CEA+Comprehensive Hepatitis B Marker" were 89.1%,84.9%,0.930 and 0.940,respectively, which were significantly higher than the combined detection of six traditional indexes(81.9% and 0.900) of AFP,CEA,CA199,ALP,GGT and TBA. Conclusion As a new indicator of HCC screening, the characteristic change of comprehensive markers of HBV infection can be combined with traditional HCC screening indicators, which can significantly improve the sensitivity of early diagno

关 键 词：联合检测 乙肝标志物 肝细胞癌 灵敏度 

分 类 号：R735.7[医药卫生—肿瘤]