摘要
目的:探讨血清异常凝血酶原(Protein induced by vitaminK absence or antagonist-Ⅱ,PIVKA-II)和甲胎蛋白(Alpha fetoprotein,AFP)联合检测对肝细胞癌(Hepatocellular carcinoma,HCC)的临床诊断价值。方法:选择169例HCC患者、141例肝硬化患者、66例慢性乙肝患者和100例健康体检者为研究对象,分别检测和比较其血清AFP、PIVKA-Ⅱ含量。进一步分析血清AFP、PIVKA-Ⅱ含量的相关性及其诊断HCC的敏感度、特异度、阳性预测值、阴性预测值、准确度,绘制ROC曲线,比较血清AFP、PIVKA-Ⅱ及二者联合检测诊断HCC的ROC。结果:(1)HCC组血清AFP、PIVKA-Ⅱ水平均显著高于肝硬化组、慢性乙肝组及健康对照组,差异具有统计学意义(P值均<0.05)。(2)与参考线下面积相比,AFP、PIVKA-ⅡROC曲线下面积均显著增加,差异具有统计学意义(P<0.01);且PIVKA-Ⅱ的曲线下面积(AUC=0.790)明显大于AFP(AUC=0.708)。(3)PIVKA-Ⅱ在对HCC诊断的敏感度、特异度、阳性预测值、阴性预测值及准确度方面均优于AFP;AFP+PIVKA-Ⅱ联合检测敏感度和阴性预测值最高(P<0.05),准确度维持在75%左右。(4)HCC患者血清AFP和PIVKA-Ⅱ水平并无显著相关性(P>0.05)。结论:血清PIVKA-Ⅱ可作为临床辅助诊断原发性肝癌的重要指标,与AFP联合检测可提高原发性肝癌的检出率。
Objective: To investigate the diagnostic value of combined detection of serum protein induced by vitaminK absence or antagonist-Ⅱ (PIVKA-Ⅱ) and alpha fetoprotein (AFP) in hepatocellular carcinoma (HCC). Methods: A total of 169 HCC patients,141 cirrhosis patients, 66 chronic hepatitis B patients and 100 healthy controls were collected. The levels of serum AFP and PIVKA-Ⅱ were detected and compared. The correlation of serum AFP and PIVKA-Ⅱ content and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the diagnosis of HCC were further analyzed. ROC curves were plotted and the ROC of serum AFP, PIVKA-Ⅱ and two combined detection for the diagnosis of HCC was compared. Results: (1) AFP level and PIVKA-Ⅱ level in HCC group was significantly higher than that in cirrhosisgroup, chronic hepatitis B group and healthy controls.The differences were statistically significant (P<0.05). (2) Compare to the areas underreference line, the areas under ROC curve of AFP and PIVKA-Ⅱ both significant increased and had statistical difference(P<0.01); the area under the ROC curve of PIVKA-Ⅱ(AUC=0.790) is much larger than that of AFP(AUC=0.708). (3)The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PIVKA-Ⅱ were superior to that of AFP in the diagnosis of HCC.The sensitivity and negative predictive value was the highest when AFP and PIVKA-Ⅱ were combined detected (P<0.05), and the accuracy was about 75 %. (4) There was no significant correlation between the levels of serum AFP and PIVKA-Ⅱ(P>0.05). Conclusions: Serum PIVKA-Ⅱ can be used as an important indicator of clinical diagnosis of primary hepatocellular carcinoma. Combined detection with AFP can increase the detection rate of primary hepatocellular carcinoma.
作者
邢瑞青
周磊
吴永昌
李静
刘杨
陈健康
彭道荣
XINGRui-qing;ZHOU Lei;WU Yong-chang;LIJing;LIU Yang;CHEN Jian-kang;PENG Dao-rong(Research institute of Clinical Laboratory Medicine of PLA, Xijing Hospital, Air Force Medical University,Xi’an,Shaanxi,710032, China)
出处
《现代生物医学进展》
CAS
2018年第22期4277-4280,共4页
Progress in Modern Biomedicine
基金
国家自然科学基金青年基金项目(81601816)
陕西省自然基础研究基金项目(S2016YFJQ1066)
