寡糖链、甲胎蛋白对乙型肝炎病毒相关肝细胞癌风险筛查与诊断价值研究  

Study on the Value of Oligosaccharide Chain and Alpha-fetoprotein for Risk Screening and Diagnosis of Hepatitis B Virus-related Hepatocellular Carcinoma

作　　者：张芸 蔡欣奕 丁靖诺 陆圣威 陈萃英 吴婷婷 张军利 赵卫峰[1] ZHANG Yun;CAI Xinyi;DING Jingnuo;LU Shengwei;CHEN Cuiying;WU Tingting;ZHANG Junli;ZHAO Weifeng(Department of Infectious Diseases,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Sysdiagno Biomedtech Co,Ltd.,Taizhou 225300,China;Sysdiagno Biomedtech Co,Ltd.,Nanjing 210000,China)

机构地区：[1]苏州大学附属第一医院感染科,江苏省苏州市215006 [2]江苏先思达生物科技有限公司,江苏省泰州市225300 [3]先思达(南京)生物科技有限公司,江苏省南京市210000

出　　处：《中国全科医学》2024年第15期1855-1860,共6页Chinese General Practice

摘　　要：背景 肝细胞癌(HCC)是原发性肝癌(PLC)的主要病理分型,与乙型肝炎病毒(HBV)感染密切相关,HCC早期无明显症状,发现时多进展至中晚期阶段,有肝内、门静脉或其他部位转移,预后较差。在疾病早期对高风险人群进行定期筛查及早期诊断,对临床治疗及预后有重大意义。目的 探究寡糖链和甲胎蛋白(AFP)在HBV相关HCC的风险人群及患者中的应用价值,为临床诊断提供参考。方法 纳入2022年1—11月就诊于苏州大学附属第一医院的慢性HBV感染患者165例为研究对象,其中非HCC患者123例,HCC患者42例。通过电子病历系统收集患者一般资料(年龄、性别、肝硬化情况)、实验室检查指标[总胆红素(TB)、白蛋白(ALB)、血小板计数(PLT)、AFP],计算慢性肝病患者肝癌风险预测模型评分(aMAP评分),收集寡糖链标志物检测结果(G-Test)。将HCC患者作为HCC组(42例),非HCC患者根据aMAP评分进行分组,<50分为低风险组(40例)、50~60分为中风险组(44例)、>60分为高风险组(39例)。绘制受试者工作特征曲线(ROC曲线)分析AFP、G-Test及两者联合诊断HCC的效能,计算ROC曲线下面积(AUC),并用DeLong检验比较联合指标与单个指标AUC的差异。采用Kappa一致性检验分析AFP、G-Test与临床诊断结果的一致性。结果 HCC组患者AFP、G-Test高于低风险组、中风险组、高风险组,年龄、肝硬化比例高于低风险组、中风险组,ALB低于低风险组、中风险组,TB低于高风险组,PLT低于低风险组(P<0.05);高风险组患者年龄、TB、G-Test高于低风险组、中风险组,ALB、PLT低于低风险组、中风险组,肝硬化比例高于低风险组(P<0.05);中风险组患者的年龄、肝硬化比例高于低风险组,PLT低于低风险组(P<0.05)。AFP和G-Test诊断HCC的AUC分别为0.796(95%CI=0.706~0.886,P<0.001)、0.878(95%CI=0.813~0.943,P<0.001),两者联合诊断HCC的AUC为0.901(95%CI=0.844~0.957,P<0.001)。DeLong检验结果显示,联合诊断HCC的AUBackground Hepatocellular carcinoma(HCC)is the main pathological type of primary liver cancer(PLC)and is closely associated with Hepatitis B virus(HBV)infection.HCC in its early stages often presents no significant symptoms and is usually discovered at an advanced stage with liver,portal vein,or other site metastases,leading to a poor prognosis.Regular screening and early diagnosis in high-risk populations in the early stages of the disease are of great significance for clinical treatment and prognosis.Objective To explore the application value of oligosaccharides and alpha-fetoprotein(AFP)in the risk population and patients of HBV-related HCC,providing a reference for clinical diagnosis.Methods The study included 165 chronic HBV infection patients treated at the First Affiliated Hospital of Soochow University from January to November 2022,comprising 123 non-HCC and 42 HCC patients.Patient data(age,gender,cirrhosis status),laboratory indices[total bilirubin(TB),albumin(ALB),platelet count(PLT),AFP]were collected through electronic medical records,and a liver cancer risk prediction model score for chronic liver disease patients(aMAP score)was calculated,along with oligosaccharide marker test results(G-Test).HCC patients were classified as the HCC group(42 cases),and non-HCC patients were divided based on aMAP scores into low-risk(<50 points,40 cases),medium-risk(50-60 points,44 cases),and highrisk(>60 points,39 cases)groups.Receiver operating characteristic(ROC)curves were plotted to analyze the efficacy of AFP,G-Test,and their combined diagnosis of HCC,calculating the area under the ROC curve(AUC),and the DeLong test was used to compare the differences between combined and single indicator AUCs.Kappa consistency tests were used to analyze the consistency of AFP and G-Test with clinical diagnostic results.Results In patients with HCC,levels of AFP and G-Test were higher compared to those in the low-risk,medium-risk,and high-risk groups(P<0.05).Additionally,age and the proportion of liver cirrhosis were higher than

关 键 词：癌 肝细胞 乙型肝炎病毒 甲胎蛋白类 寡糖链检测 癌症筛查 早期诊断 受试者工作特征曲线 

分 类 号：R730.261[医药卫生—肿瘤]