血清异常凝血酶原和甲胎蛋白在布-加综合征合并肝细胞癌中的诊断价值  

Diagnostic value of PIVKA-Ⅱand AFP in Budd-Chiari syndrome associated with hepatocellular carcinoma

作　　者：刘龙 郭潇 赵云龙 蒋明明 刘洪涛 王文亮 祖茂衡 徐浩 LIU Long;GUO Xiao;ZHAO Yunlong;JIANG Mingming;LIU Hongtao;WANG Wenliang;ZU Maoheng;XU Hao(Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department of Invasive Technology,Huai'an Huai'an Hospital,Huai'an,Jiangsu 223200,China;Department of Interventional Radiology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221006,China)

机构地区：[1]徐州医科大学研究生学院,江苏徐州221004 [2]淮安市淮安医院介入科,江苏淮安223200 [3]徐州医科大学附属医院介入放射科,江苏徐州221006

出　　处：《安徽医药》2024年第11期2264-2268,共5页Anhui Medical and Pharmaceutical Journal

基　　金：江苏省医学重点学科创新团队项目(CXTDA2017028)。

摘　　要：目的探讨血清异常凝血酶原(PIVKA-Ⅱ)、甲胎蛋白(AFP)在布-加综合征(BCS)合并肝细胞癌(HCC)中的诊断价值。方法收集2015年6月至2021年10月徐州医科大学附属医院收治的43例BCS合并HCC病人和139例单纯BCS病人临床资料,采用倾向性评分匹配法平衡两组特征差异,匹配后BCS合并HCC组31例、单纯BCS组53例。比较血清PIVKA-Ⅱ和AFP水平对BCS合并HCC的诊断效能,分析其与病人病变特征的关系。结果BCS合并HCC组血清PIVKA-Ⅱ[247(77,5259)AU/L比17(13,22)AU/L]和AFP水平[444.20(12.38,5484.00)μg/L比3.35(2.16,8.43)μg/L]均显著高于BCS组(均P<0.01)。PIVKA-Ⅱ和AFP联合检测诊断BCS合并HCC的AUC高于PIVKA-Ⅱ、AFP单独检测(0.98比0.92、0.90),其中联合检测AUC较AFP单独检测差异有统计学意义(P<0.05)。在BCS合并HCC病人中,多发HCC病灶、肿瘤长径之和≥5cm、CNLCⅢ~Ⅳ期和合并门静脉瘤栓病人的PIVKA-Ⅱ分别高于单发病灶、肿瘤长径之和<5 cm、CNLCⅠ~Ⅱ期和无门静脉瘤栓的病人(均P<0.05);单发病灶病人血清PIVKA-Ⅱ(r=0.58,P=0.018)和AFP(r=0.46,P=0.035)阳性水平与肿瘤长径正相关。结论PIVKA-Ⅱ和AFP对BCS合并HCC均具有较高的诊断价值,PIVKA-Ⅱ联合AFP可提高诊断效能,且PIVKA-Ⅱ和AFP与病人病变特征密切相关。Objective To investigate the clinical value of protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)and alpha fetoprotein(AFP)in the diagnosis of Budd-Chiari syndrome associated with hepatocellular carcinoma.Methods Clinical data of 43 patients with BCS combined with HCC and 139 patients with BCS alone admitted to the Affiliated Hospital of Xuzhou Medical University from June 2015 to October 2021 were collected.The propensity score matching method was used to balance the differences between the two groups.After matching,31 cases of BCS-associated HCC and 53 cases of BCS alone were obtained.The diagnostic efficacy of serum PIVKA-Ⅱand AFP levels on BCS-combined with HCC was compared,and their relationship with the the lesion characteristics of patients was analyzed.Results The serum PIVKA-Ⅱ[247(77,5259)AU/L vs.17(13,22)AU/L]and AFP levels[444.20(12.38,5484.00)μg/L vs.3.35(2.16,8.43)μg/L]in the BCS-associated HCC group were significantly higher than those in the BCS group(P<0.01).The AUC of PIVKA-Ⅱand AFP combined detection for the diagnosis of BCS-combined with HCC was higher than that of PIVKA-Ⅱand AFP alone(0.98 vs.0.92,0.90),and the AUC of the combined test was statistically different than that of AFP alone(P<0.05).In patients with BCS combined with HCC,PIVKA-Ⅱwas higher in patients with multiple HCC lesions,sum of tumor diameters≥5 cm,CNLC stagesⅢ-Ⅳ,and combined with portal vein carcinoma thrombosis than in patients with single lesions,sum of tumor diameters<5 cm,CNLC stagesⅠ-Ⅱ,and no portal vein carcinoma thrombosis,respectively(P<0.05);The positive levels of serum PIVKA-Ⅱ(r=0.58,P=0.018)and AFP(r=0.46,P=0.035)in patients with single lesions were positively correlated with tumor diameter.Conclusions Both PIVKA-Ⅱand AFP have high diagnostic value for BCS-associated HCC,PIVKA-Ⅱcombined with AFP can improve the diagnostic efficiency.PIVKA-Ⅱand AFP are closely related to the lesion characteristics of patients.

关 键 词：布-加综合征 癌 肝细胞 合并症 异常凝血酶原 甲胎蛋白 倾向性匹配评分 

分 类 号：R735.7[医药卫生—肿瘤] R575[医药卫生—临床医学]