AFP、AFU、CEA、PIVKA-Ⅱ及凝血因子检测在乙型肝炎相关肝癌中的诊断价值  

Diagnostic value of AFP,AFU,CEA,PIVKA-Ⅱand coagulation factor in hepatitis B-associated liver cancer

作　　者：黄鑫[1] 堵妍 张媛媛 HUANG Xin;DU Yan;ZHANG Yuan-yuan(Department of Clinicl Laboratory,The Fourth People's Hospital of Huai'an,Huai'an 223002,China)

机构地区：[1]淮安市第四人民医院检验科,江苏淮安223002

出　　处：《哈尔滨医科大学学报》2024年第6期623-627,共5页Journal of Harbin Medical University

基　　金：江苏省卫生健康委基金项目(ZD2022041);淮安市科技项目(HAB202125)。

摘　　要：目的 探讨乙型肝炎相关肝癌患者肿瘤标志物α-L-岩藻糖苷酶(α-l-fucosidase, AFU)、甲胎蛋白(alpha-fetoprotin, AFP)、癌胚抗原(carcinoembryonic antigen, CEA)、异常凝血酶原(abnormal prothrombin, PIVKA-Ⅱ)以及凝血因子的诊断价值。方法 筛选2019年3月~2022年12月淮安市第四人民医院的乙型肝炎患者202例,根据疾病严重程度分肝癌组(36例)、肝硬化组(99例)、肝炎组(67例)。收集3组患者临床资料及实验室检查指标。应用受试者工作特征(receiver operating characteristic, ROC)曲线比较分析凝血因子及AFP、AFU、CEA、PIVKA-Ⅱ诊断乙肝相关肝癌的效能。用二元Logistic回归方法分析肝癌的独立危险因素。结果 肝癌组年龄高于肝硬化组和乙型肝炎组,HBeAg阳性率显著低于另两组(P<0.05)。肝癌组谷氨酰转肽酶(glutamyltranspeptidase, GGT)高于肝硬化组和乙型肝炎组,肌酐(creatinine, CREA)低于另两组,丙氨酸转氨酶(alanine aminotransferase, ALT)、天冬氨酸转氨酶(aspartate aminotransferase, AST)高于肝硬化组,低于乙型肝炎组(P<0.05)。肝癌组凝血酶原时间(prothrombin time, PT)短于肝硬化组,长于乙型肝炎组,活化部分凝血活酶时间(activated partial thromboplastin time, APTT)短于另两组,纤维蛋白原(fibrinogen, FIB)结果高于另两组(P<0.05)。肝癌组AFU、AFP、PIVKA-Ⅱ均高于另两组(P<0.05)。绘制ROC曲线发现,FIB及血清肿瘤标志物对乙型肝炎相关肝癌均有诊断价值,联合检测均对乙型肝炎相关肝癌有较高诊断价值,AUC分别为0.719、0.767和0.754。二元Logistic回归分析显示,年龄(OR=1.065,95%CI:1.003~1.132,P=0.041)、PT(OR=1.441,95%CI:1.033~2.009,P=0.032)、APTT(OR=0.842,95%CI:0.737~0.962,P=0.012)、FIB(OR=3.279,95%CI:1.443~7.449,P=0.005)是乙型肝炎患者进展为肝癌的独立危险因素。结论 年龄、PT、APTT和FIB检测是乙肝进展为肝癌的独立危险因素。凝血因子检测联合AFP、AFU、PIVKA-Ⅱ对乙肝相关肝癌具有Objective To explore the diagnostic value ofα-l-fucosidase(AFU),alpha-fetopro-tein(AFP),carcinoembryonic antigen(CEA),abnormal prothrombin(PIVKA-Ⅱ)and coagu-lation factor in hepatitis B-related liver cancer.Methods A total of 202 patients with hepatitis B admitted to the Fourth People's Hospital of Huai'an from March 2019 to December 2022 were selected and divided into liver cancer group(36 cases),cirrhosis group(99 cases)and hepatitis group(67 cases)according to the severity of the disease.Clinical data and laboratory indicators of 3 groups of patients were collected.The efficacy of coagulation factor,AFP,AFU,CEA and PIVKA-Ⅱin the diagnosis of hepatitis B liver cancer was compared by receiver operating characteristic(ROC)curve.The independent risk factors of liver cancer were ana-lyzed by binary Logistic regression.Results The age of hepatocellular carcinoma group was higher than that of cirrhosis group and hepatitis B group,and the positive rate of HBeAg was lower than that of the other two groups(P<0.05).The glutamyltranspeptidase(GGT)of hep-atocellular carcinoma group was higher than that of liver cirrhosis group and hepatitis B group,the creatinine(CREA)was lower than that of the two groups,and the alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were higher than that of hepatocellular carcinoma group and lower than that of hepatitis B group(P<0.05).The prothrombin time(PT)in hep-atocellular carcinoma group was shorter than that in cirrhosis group and longer than that in hep-atitis B group,the activated partial thromboplastin time(APTT)was shorter than the other two groups,and the results of fibrinogen(FIB)were higher than those of the other two groups(P<0.05).The levels of AFU,AFP and abnormal PIVKA-Ⅱin HCC group were higher than those in the other two groups(P<0.05).The ROC curve showed that both FIB and serum tumor markers had diagnostic value for hepatitis B-associated liver cancer(AUC>0.5).The com-bined detection showed that the combined diagnosis of coagulation factor,serum tumor

关 键 词：乙型肝炎 肝癌 凝血因子 血清肿瘤标志物 诊断 危险因素 

分 类 号：R446.1[医药卫生—诊断学]