血清PIVKA-Ⅱ、AFP、ALB和PA联合检测在原发性肝癌诊断中的价值  

The value of combined serum PIVKA-Ⅱ,AFP,ALB,and PA in the diagnosis of primary liver cancer

作　　者：田斌 康从利[1] 董彦军[1] 时会芳 徐静 TIAN Bin;KANG Cong-li;DONG Yan-jun(The Laboratory Department,People's Hospital of Rizhao,Shandong Rizhao 276800)

机构地区：[1]日照市人民医院检验科,山东日照276800 [2]日照市人民医院产科,山东日照276800

出　　处：《医学检验与临床》2025年第3期1-6,33,共7页Medical Laboratory Science and Clinics

基　　金：山东省医药卫生科技发展计划项目,项目编号:202002080284。

摘　　要：目的:探究血清异常凝血酶原(PIVKA-Ⅰ)、甲胎蛋白(AFP)、白蛋白(ALB)和前白蛋白(PA)联合检测在原发性肝癌(PHC)诊断中的临床应用价值。方法:选取2023年1月-2024年11月在日照市人民医院首次确诊的50例原发性肝癌患者为研究对象(PHC组),同时选取同期来医院就诊的50例肝硬化(LC)患者(良性对照组)及53例健康体检者(正常对照组)作对照,三组人群均有血清PIVKA-Ⅰ、AFP、ALB和PA检查资料,回顾性分析PIVKA-Ⅰ、AFP、ALB和PA联合检测在PHC诊断中的应用价值。结果:PHC组血清PIVKA-Ⅱ、AFP水平[(432.56±82.37)mAu/mL、(106.48±20.13)ng/mL]均高于LC组[(28.64±5.13)mAu/mL、(10.07±3.25)ng/mL)和正常对照组[(27.78±4.26)mAu/mL、(8.97±3.56)ng/mL];PHC组血清ALB和PA水平[(34.05±3.17)g/L、(148.57±21.34)mg/L)均低于LC组[(41.29±4.22)g/L、(162.0±23.47)mg/L)和正常对照组[(44.20±5.13)g/L、(293.0±30.17)mg/L,差异均有统计学意义(P均<0.01),LC组与正常对照组血清PIVKA-Ⅱ和AFP水平比较差异无统计学意义(P均≥0.05),而LC组血清ALB和PA水平明显低于正常组(P均<0.01)。PHC组肿瘤直径>2cm、临床高分期(Ⅱ~Ⅳ期)、伴腹水、转移者血清PIVKA-Ⅰ、AFP水平均高于肿瘤直径≤2cm、临床低分期(Ⅰ~Ⅱ期)、无腹水、无转移者血清水平,而ALB、PA表达水平与之相反(P均<0.01);Logistic多因素回归分析表明血清PIVKA-Ⅱ、AFP、ALB、PA均是发生PHC的独立危险因素;受试者工作特征(ROC)曲线显示PIVKA-Ⅱ、AFP、ALB、PA及四项联合检测诊断PHC曲线下面积(AUC)分别为0.901、0.773、0.833、0.831和0.982,敏感性分别为80.00%、60.00%、78.00%、72.00%、90.00%,联合检测诊断PHC的AUC、敏感度明显高于各单项检测(P<0.05)。结论:血清PIVKA-Ⅱ、AFP、ALB、PA均可以作为协助诊断PHC的血清学指标,四项联合检测明显提高协助诊断PHC效能。Objective:To investigate the clinical application value of the combined detection of serum abnormal prothrombin(PIVKA-II),alpha-fetoprotein(AFP),albumin(ALB)and prealbumin(PA)in the diagnosis of primary liver cancer(PHC).Methods:A total of 50 patients with primary liver cancer who were first diagnosed in Rizhao People's Hospital from January 2023 to November 2024 were selected as the study subjects(PH group),and 50 patients with liver cirrhosis(LC)(benign control group)and 53 healthy patients(normal control group)who came to the hospital during the same period were selected as controls.Serum PIVKA-I,AFP,ALB and PA were detected in all three groups,and the application value of combined detection of PIVKA-I,AFP,ALB and PA in the diagnosis of PHC was retrospectively analyzed.Results:The serum levels ofPIVKA-II.and AFP in the PHC group[432.56±82.37)mAu/mL and(106.48±20.13)ng/mL)were significantly higher than those in the LC group[(28.64±5.13)mAu/mL,(10.07±3.25)ng/mL]and the normal control group[(27.78±4.26)mAu/mL and(8.97±3.56)ng/mL),The serum levels of ALB and PA in the PHC group[(34.05±3.17)g/L and(148.57±21.34)mg/L]were significantly lower than those in the LC group[(41.29±4.22)g/L and(162.0±23.47)mg/L]and the normal control group[(44.20±5.13)g/L and(293.0±30.17)mg/L)(P<0.01),and there was no significant dfference in serum PIVKA-II and AFP levels between the LC group and the normal control group(P>0.05),while the serum levels of ALB and PA in the LC group were significantly lower than those in the normal group(P<0.01):In the PHC group,the tumor diameter was>2 cm,the clinical stage was high(stage III-IV),and the tumor was accompanied by ascites and metastasis Serum levels of PIVKA-II and AFPThe serum levels were higher than those in patients with tumor diameter of≤2 cm,low clinical stage(stage I~Ⅱ),no ascites,and no metastasis,The expression levels of ALB and PA were opposite(P<0.01).Logistic multivariate regression analysis showed that serum PIVKA-II,AFP,ALB,and PA were independent risk factors for

关 键 词：原发性肝癌 血清学 联合检测 诊断价值 

分 类 号：R735.7[医药卫生—肿瘤]