PIVKA-Ⅱ、GGT、GPR、GLR、PLR对乙型肝炎相关性原发性肝癌的诊断价值研究  

Diagnostic value of the PIVKA-Ⅱ,GGT,GPR,GLR and PLR for the development of hepatitis B virus related primary hepatocellular carcinoma

作　　者：黄琴 彭晓明[1,2] 梅丽萍 韩竖霞 HUANG Qin;PENG Xiao-ming;MEI Li-ping(Department of Clinical Laboratory,Hubei Provincial Hospital of Traditional Chinese Medicine(Wuhan,430061),China)

机构地区：[1]湖北省中医院检验科,湖北武汉430061 [2]湖北省中医药研究院 [3]中医肝肾研究及应用湖北省重点实验室

出　　处：《中西医结合肝病杂志》2024年第4期327-330,共4页Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases

摘　　要：目的:探讨维生素K缺乏或拮抗剂-Ⅱ诱导蛋白(PIVKA-Ⅱ)、γ-谷氨酰转肽酶(GGT)、γ谷氨酰转肽酶与血小板计数比值(GPR)、γ-谷氨酰转肽酶与淋巴细胞计数比值(GLR)、血小板患者与淋巴细胞计数比值(PLR)在乙型肝炎病毒(HBV)感染后所致不同肝脏疾病患者中的变化情况以及单独和联合检测对乙型肝炎相关性原发性肝癌的诊断价值。方法:回顾性分析2020年1月至2022年12月收治的241例HBV相关性肝病患者的临床资料,其中慢性乙型肝炎(CHB)患者83例,乙型肝炎相关性肝硬化(HBV-LC)患者82例,乙型肝炎相关性原发性肝癌(HBV-HCC)患者76例,另选取同期健康体检人员81例为正常对照组(NC)。统计分析4组患者的PIVKA-Ⅱ、GGT、GPR、GLR、PLR表达差异以及血清PIVKA-Ⅱ、GGT的阳性率情况;Pearman线性相关分析HBV-HCC组患者的GLR、GPR、PLR指标与血清PIVKA-Ⅱ、GGT的相关性;采用ROC曲线分析PIVKA-Ⅱ、GGT、GLR、GPR、PLR单独与联合检测对HBV-HCC的诊断价值。结果:CHB组、HBV-LC组、HBV-HCC组患者的PIVKA-Ⅱ、GGT、GLR、GPR水平依次增加,其中两两组比较,GGT、GLR、GPR水平均差异有统计学意义(P<0.05),HBV-HCC组的PIVKA-Ⅱ表达水平高于CHB组、HBV-LC组(P<0.05)。CHB组、HBV-LC组的PIVKA-Ⅱ、PLR水平均低于NC组(P<0.05)。HBV-HCC组血清PIVKA-Ⅱ、GGT阳性率都大于50%。HBV-HCC组患者的GLR、GPR、PLR与血清PIVKA-Ⅱ、GGT均呈正相关。PIVKA-Ⅱ、GGT、GLR、GPR联合检测的诊断敏感度曲线下面积(AUC)以及约登(Youden)指数均高于PIVKA-Ⅱ、GGT、GLR、GPR、PLR单独检测,GGT、GLR、GPR三者联合检测的特异度达到95.06%。结论:PIVKA-Ⅱ、GGT、GPR、GLR、PLR在HBV感染所致不同肝脏疾病患者中具有一定的差异,PIVKA-Ⅱ、GGT、GPR、GLR联合检测有助于HBV-HCC的早期诊断。Objective:To explore the changes of vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ),γ-glutamyl transpeptidase(γ-GGT),γglutamyl transpeptidase to platelet ratio(GPR),γglutamyl transpeptidase to lymphocyte count ratio(GLR),platelet to lymphocyte count ratio(PLR)in patients with different liver diseases caused by hepatitis B virus(HBV)infection,as well as the predictive value of the primary and combined detection in hepatitis B associated primary liver cancer.Methods:A retrospective analysis was performed on 241 HBV-related liver disease treated in our hospital between January 2020 and December 2022,including 83 patients with chronic hepatitis B(CHB),82 patients with hepatitis B-related liver cirrhosis(HBV-LC),76 patients with primary liver cancer related to hepatitis B(HBV-HCC).At the same period,and 81 cases of health check-up personnel were selected as the normal control group(NC).The expression differences of PIVKA-Ⅱ,GGT,GPR,GLR and PLR and the positive rate of PIVKA-Ⅱand GGT in the four groups were statistically analyzed;Pearson linear correlation analysis was performed to determine the correlation between GLR,GPR,PLR and serum PIVKA-Ⅱ,GGT in HBV-HCC group;ROC curve was used to analyze the diagnostic value of PIVKA-Ⅱ,GGT,GLR,GPR and PLR alone and in combination with HBV-HCC.Results:The expression levels of PIVKA-Ⅱ,GGT,GLR and GPR in CHB group,HBV-LC group and HBV-HCC group increased successively,and the expression levels of GGT,GLR and GPR were statistically significant compared with the two groups(P<0.05).The PIVKA-Ⅱexpression level of HBV-HCC group was higher than that of CHB group and HBV-LC group,and the differences were statistically significant(P<0.05).The expression levels of PIVKA-Ⅱand PLR in CHB and HBV-LC groups were lower than NC group.The differences were statistically significant(P<0.05).The positive rates of PIVKA-Ⅱand GGT in HBV-HCC group were more than 50%.There was a positive correlation between GLR,GPR,PLR and PIVKA-Ⅱ,GGT in HBV-HCC group,The diagnostic sensitivity,AUC and

关 键 词：乙型肝炎相关性原发性肝癌 维生素K缺乏或拮抗剂-Ⅱ诱导蛋白 Γ-谷氨酰转肽酶 γ-谷氨酰转肽酶与血小板比值 γ-谷氨酰转肽酶与淋巴细胞计数比 血小板计数与淋巴细胞计数比值 诊断价值 

分 类 号：R575[医药卫生—消化系统]