血清CEA、AFP及PIVKA-II联合检测对肝炎病毒相关肝细胞癌的诊断价值  

Diagnostic value of serum CEA,AFP and PIVKA-Ⅱin hepatitis virus-related hepatocellular carcinoma

作　　者：杨潇 张爱荣 陶玉梅 YANG Xiao;ZHANG Airong;TAO Yumei(Department of Laboratory Medicine,Zhumadian Central Hospital,Henan 463000)

机构地区：[1]驻马店市中心医院检验科,河南463000

出　　处：《交通医学》2025年第1期8-12,共5页Medical Journal of Communications

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20191024)。

摘　　要：目的:探讨血清癌胚抗原(carcino-embryonic antigen,CEA)、甲胎蛋白(alpha fetoprotein,AFP)及维生素K缺乏或拮抗剂-II诱导的蛋白质(protein induced by vitamin K absence or antagonist-II,PIVKA-II)对肝炎病毒相关肝细胞癌(hepatocellular carcinoma,HCC)的诊断价值。方法:回顾性分析174例乙型肝炎病毒和丙型肝炎病毒相关肝病患者的临床资料,其中慢性乙肝组32例、乙肝肝细胞癌组51例、乙肝肝硬化组45例、丙肝肝细胞癌组23例及丙肝肝病组23例。比较各组血清中CEA、AFP及PIVKA-II水平,绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under curve,AUC),分析血清CEA、AFP及PIVKA-II水平对肝细胞癌的诊断价值。结果:乙肝肝硬化组和乙肝肝癌组患者血清CEA、AFP和PIVKA-Ⅱ水平高于慢性乙肝组,乙肝肝癌组CEA、AFP和PIVKA-Ⅱ水平高于乙肝肝硬化组(均P<0.05)。丙肝肝癌组血清CEA、AFP和PIVKA-Ⅱ水平高于丙肝肝病组(均P<0.05)。ROC曲线分析显示,血清CEA、AFP及PIVKA-Ⅱ单独诊断乙肝肝细胞癌的AUC分别为0.734、0.745和0.770,三者联合诊断的AUC升至0.841,敏感度为84.67%,特异度为79.18%。血清CEA、AFP及PIVKA-Ⅱ单独诊断丙肝肝细胞癌的AUC分别为0.802、0.791和0.782,三者联合诊断的AUC升至0.909,特异度为82.59%,敏感度为84.54%。结论:单独检测血清PIVKA-Ⅱ水平对肝炎病毒相关肝细胞癌具有较高诊断效能,与CEA、AFP联合检测能进一步提高肝细胞癌的诊断效能。Objective:To explore the diagnostic value of serum carcino-embryonic antigen(CEA),alpha fetoprotein(AFP),protein induced by vitamin K absence or antagonist-II(PIVKA-Ⅱ)in hepatitis virus-related hepatocellular carcinoma(HCC).Methods:The clinical data of 174 patients with hepatitis B virus(HBV)and hepatitis C virus(HCV)related liver disease were analyzed retrospectively,including 32 patients in the chronic hepatitis B group,51 patients in the hepatitis B HCC group,45 patients in the hepatitis B cirrhosis group,23 patients in the hepatitis C HCC group and 23 patients in the hepatitis C liver disease group.The serum levels of CEA,AFP and PIVKA-II were detected and compared in each group.The receiver operating characteristic(ROC)curve was plotted and the area under curve(AUC)was calculated to analyze the diagnostic value of serum CEA,AFP and PIVKA-II levels in hepatocellular carcinoma.Results:The levels of CEA,AFP and PIVKA-Ⅱin the hepatitis B cirrhosis group and the hepatitis B HCC group were higher than those in the chronic hepatitis B group,and the levels of CEA,AFP and PIVKA-Ⅱin the hepatitis B HCC group were higher than those in the hepatitis B cirrhosis group(P<0.05).The levels of serum AFP,CEA and PIVKA-Ⅱin the hepatitis C HCC group were significantly higher than those in the hepatitis C liver disease group(P<0.05).ROC curve analysis showed that the AUC of serum CEA,AFP and PIVKA-Ⅱalone in the diagnosis of hepatitis B hepatocellular carcinoma was 0.734,0.745 and 0.770,respectively,and the AUC of serum CEA,AFP and PIVKA-Ⅱcombined diagnosis increased to 0.841,with a sensitivity of 84.67%and a specificity of 79.18%.The AUC of serum CEA,AFP and PIVKA-Ⅱalone in the diagnosis of hepatitis C hepatocelluar carcinoma was 0.802,0.791,0.782,and the AUC of serum CEA,AFP and PIVKA-Ⅱcombined diagnosis increased to 0.909,with a specificity of 82.59%and a sensitivity of 84.54%.Conclusion:Serum PIVKA-II alone has high diagnostic efficacy for hepatitis virus-related hepatocellular carcinoma,and combined detection

关 键 词：维生素K缺乏或拮抗剂-II诱导的蛋白质 癌胚抗原 甲胎蛋白 肝炎病毒 肝细胞癌 诊断价值 

分 类 号：R735.7[医药卫生—肿瘤]