PIVKA-Ⅱ、AFP、AFP-L3、CEA及不同组合模式在转移性肝细胞癌诊断中的应用及评分模型的构建  

The application of PIVKA-Ⅱ,AFP,AFP-L3,CEA and different combination modes in the diagnosis of metastatic hepatocellular carcinoma and the construction of the scoring model

作　　者：鲍彩丽 侯仁花 刘艳 王迎秋 BAO Caili;HOU Renhua;LIU Yan;WANG Yingqiu(Department of Laboratory Medicine,Yangpu Hospital,Tongji University,Shanghai 200090,China;Department of Nuclear Medicine,Yangpu Hospital,Tongji University,Shanghai 200090,China)

机构地区：[1]同济大学附属杨浦医院检验科,上海200090 [2]同济大学附属杨浦医院核医学科,上海200090

出　　处：《胃肠病学和肝病学杂志》2024年第11期1514-1519,共6页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的探讨维生素K缺乏或拮抗剂诱导的蛋白质(protein induced by vitamin K absence or antagonist-Ⅱ,PIVKA-Ⅱ)、甲胎蛋白(α-fetoprotein,AFP)、甲胎蛋白异质体L3(α-fetoprotein heterogeneity-L3,AFP-L3)、癌胚抗原(carcinoembryonic antigen,CEA)及不同组合模式在转移性肝细胞癌诊断中的应用及评分模型的构建。方法收集2019年1月至2022年7月我院283例肺癌、肠癌患者的血清,根据是否发生肝转移分为试验组(发生肝转移,n=70)和对照组(未发生肝转移,n=213),检测血清肿瘤标记物PIVKA-Ⅱ、AFP、AFP-L3、CEA的水平。比较各指标及其不同组合对转移性肝细胞癌筛查的敏感度、特异度,并绘制ROC曲线。通过单因素和多因素分析转移性肝细胞癌的独立影响因素,建立转移性细胞癌预测模型并验证。结果与对照组相比,试验组患者PIVKA-Ⅱ、AFP、AFP-L3、CEA的水平显著升高,差异有统计学意义(P<0.05)。两组在结肠息肉、脂肪肝、肿瘤大小、阳性淋巴结数目等方面比较,差异有统计学意义(P<0.05)。PIVKA-Ⅱ、AFP、AFP-L3、CEA、患有结肠息肉、脂肪肝、肿瘤≥5 cm、有阳性淋巴结是转移性肝细胞癌的独立危险因素(P<0.05)。在不同的组合指标中,PIVKA-Ⅱ+AFP+AFP-L3+CEA组合在敏感度和特异度等参数之间可达到相对最佳的平衡。对进入回归方程的指标进行风险评分,其中患有结肠息肉、患有脂肪肝、肿瘤大小≥5 cm、PIVKA-Ⅱ≥40 mAU/mL、AFP≥8.3 ng/mL、AFP-L3≥10%、CEA≥5.7 ng/mL七项指标分别设定为2、2、2、3、3、1.5、3.5分。总分在1.5~17分,根据百分位数进行评分分级,低危组<7分,中危组7~12.5分,高危组>12.5分,结果显示随着评分增加,转移性肝细胞癌风险增加。结论PIVKA-Ⅱ+AFP+AFP-L3+CEA组合在敏感度和特异度等参数之间可达到相对最佳的平衡,依据转移性肝细胞癌风险预测模型制定的评分标准有良好的预测性。Objective To investigate the application of protein induced by vitamin K absence or antagonist-Ⅱ,(PIVKA-Ⅱ),α-fetoprotein(AFP),α-fetoprotein heterogeneous-L3(AFP-L3),carcinoembryonic antigen(CEA)and different combinations in the diagnosis of metastatic hepatocellular carcinoma and the construction of scoring models.Methods The serum of 283 hospitalized patients with lung cancer and colon cancer from Jan.2019 to Jul.2022 was collected and divided into experimental group(liver metastasis,n=70)and control group(no liver metastasis,n=213),and the levels of PIVKA-Ⅱ,AFP,AFP-L3 and CEA were tested,respectively.The efficacy of PIVKA-Ⅱ,AFP,AFP-L3,CEA and different combinations of screening for metastatic hepatocellular carcinoma was analyzed to calculate the sensitivity and specificity,and draw the ROC curve.The prediction model of liver metastasis in cancer patients were established by univariate and multivariate analysis.Results There was a statistically significant difference between two groups interms of PIVKA-Ⅱ,AFP,AFP-L3,CEA,colon polyps,fatty liver,tumor size and number of positive lymph nodes(P<0.05).PIVKA-Ⅱ,AFP,AFP-L3,CEA,colonic polyps,fatty liver,tumor≥5 cm,and positive lymph nodes were independent risk factors for liver metastasis in patients with cancer(P<0.05).Among the different combination indicators,the PIVKA-Ⅱ+AFP+AFP-L3+CEA combination achieved a relatively optimal balance between parameters such as sensitivity and specificity.In the regression equation,in which they had colon polyp,fatty liver,tumor size≥5 cm,PIVKA-Ⅱ≥40 mAU/mL,AFP≥8.3 ng/mL,AFP-L3≥10%,CEA≥5.7 ng/mL,these 7 indicators were set to 2,2,2,3,3,1.5 and 3.5 points,respectively.The total score ranged from 1.5 to 17,and was graded according to the percentile,<7 scores in the low-risk group,7 to 12.5 scores in the intermediate-risk group,and>12.5 scores in the high-risk group.Conclusion The combination of PIVKA-Ⅱ+AFP+AFP-L3+CEA can achieve a relatively optimal balance between sensitivity and specificity,and it can

关 键 词：PIVKA-Ⅱ AFP AFP-L3 CEA 转移性肝细胞癌 评分模型 

分 类 号：R735.7[医药卫生—肿瘤]