血清甲胎蛋白、甲胎蛋白异质体3比率、高尔基体蛋白73水平对乙型肝炎相关原发性肝癌的诊断价值  

Diagnostic value of serum alpha fetoprotein,alpha-fetoprotein-L-3 ratio and golgi protein 73 level on hepatitis B-related primary liver cancer

作　　者：袁文利 汤磊[1] 张振华[1] 邹桂舟[1] Yuan Wenli;Tang lei;Zhang Zhenhua;Zou Guizhou(Department of Infectious Diseases,Second Affiliated Hospital of Anhui Medical University,Anhui Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院感染科,安徽合肥230601

出　　处：《中国肝脏病杂志（电子版）》2024年第3期17-21,共5页Chinese Journal of Liver Diseases：Electronic Version

基　　金：安徽省人力资源和社会保障厅科研基金资助项目(2021H265);安徽医科大学第二附属医院2020年新技术新项目(2020XJS32)。

摘　　要：目的探讨血清甲胎蛋白(alpha fetoprotein,AFP)、甲胎蛋白异质体3比率(alphafetoprotein-L-3 ratio,AFP-L3%)和高尔基体蛋白73(golgi protein73,GP73)水平对乙型肝炎相关原发性肝癌(primary liver cancer,PLC)的诊断价值。方法以2018年1月至2023年7月安徽医科大学第二附属医院肝病科门诊和住院的182例乙型肝炎病毒(hepatitis B virus,HBV)感染者为研究对象,其中原发性肝癌患者60例(PLC组),肝硬化患者85例(肝硬化组),慢性乙型肝炎(chronic hepatitis B,CHB)患者37例(肝炎组),检测各组患者血清AFP、AFP-L3%和GP73水平。采用受试者工作特征(receiver operating characteristic,ROC)曲线评价AFP、AFP-L3%、GP73及联合检测对PLC的诊断效能。结果PLC组患者AFP(中位数:116μg/L比5.32μg/L比5.08μg/L)、AFP-L3%(中位数:5.23μg/L比0μg/L比0μg/L)水平显著高于肝硬化组和肝炎组(P均<0.05),3组间GP73水平差异无统计学意义(中位数:84.09μg/L比95.22μg/L比64.57μg/L;H=1.52,P=0.47)。AFP、AFP-L3%、GP73、AFP+AFP-L3%和AFP+AFP-L3%+GP73诊断PLC的ROC曲线下面积分别为0.79、0.78、0.49、0.83、0.81。三者联合诊断的特异度(89.10%)和总有效率(81.82%)最高。结论AFP和AFP-L3%作为PLC的辅助诊断指标时具有良好的诊断价值,而GP73的诊断价值相对较低。AFP、AFP-L3%、GP73联合检测可提高PLC诊断的特异度,对PLC诊断具有较高的临床价值。Objective To investigate the diagnostic value of alpha fetoprotein(AFP),alphafetoprotein-L-3 ratio(AFP-L3%)and golgi protein 73(GP73)on hepatitis B-related primary liver cancer(PLC).Method A total of 182 patients with hepatitis B virus infection who were admitted to the outpatient and inpatient department of the Department of Infectious Diseases,Second Affiliated Hospital of Anhui Medical University from January 2018 to July 2023 were selected.Among them,there were 60 patients with primary liver cancer(PLC group),85 patients with liver cirrhosis(liver cirrhosis group)and 37 patients with chronic hepatitis B(CHB group).Serum AFP,AFP-L3%,and GP73 levels of patients in each group were detected.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of AFP,AFP-L3%,GP73 and combined detection on PLC.Results The levels of AFP(median:116μg/L vs.5.32μg/L vs.5.08μg/L)and AFP-L3%(median:5.23μg/L vs.0μg/L vs.0μg/L)of patients in liver cancer group were significantly higher than those of liver cirrhosis group and CHB group(all P<0.05),while there was no statistically significant difference in GP73 levels among the three groups(median:84.09μg/L vs.95.22μg/L vs.64.57μg/L;H=1.52,P=0.47).The area under the ROC curve for diagnosing PLC of AFP,AFP-L3%,GP73,AFP+AFP-L3%and AFP+AFP-L3%+GP73 were 0.79,0.78,0.49,0.83 and 0.81,respectively.The combined detection of the three indicators had the highest specificity(89.10%)and total effective rate(81.82%).Conclusions AFP and AFP-L3%had good diagnostic value as auxiliary diagnostic indicators on PLC,while GP73 had relatively low diagnostic value.The combined detection of AFP,AFP-L3%and GP73 could improve the specificity of PLC diagnosis and had high clinical value for the diagnosis of PLC.

关 键 词：肝炎病毒 乙型 肝硬化 原发性肝癌 甲胎蛋白 甲胎蛋白异质体3比率 高尔基体跨膜糖蛋白73 

分 类 号：R735.7[医药卫生—肿瘤] R512.62[医药卫生—临床医学]