摘要
目的评估玻连蛋白(vitronectin,VTN),ɑ-1-B糖蛋白(alpha1 B glycoprotein,A1BG),抗凝血酶Ⅲ(antithrombin-Ⅲ,AT-Ⅲ),甲胎蛋白(alpha fetoprotein,AFP)对肝细胞癌(hepatocellular carcinoma,HCC)的诊断价值,筛选最佳检测组合.方法利用ELISA方法检测160例HCC患者,70例慢性乙肝肝炎(chronic hepatitis B,CH)患者,70例乙肝肝硬化(Liver cirrhosis,LC)患者和50例健康对照(health comparison,HC)人员的血清VTN,A1BG,AT-Ⅲ浓度,电化学发光方法检测AFP浓度,分别比较玻连蛋白(VTN),A1BG,AT-Ⅲ,AFP在HCC组,LC组,CH组,HC组中变化情况;应用ROC曲线分析血清AFP,HRG,A1BG和AT-Ⅲ单项及联合检测HCC的敏感度和特异度;并以肝病状态(HCC组,非HCC组)为应变量,血清AFP,A1BG和AT-Ⅲ测定结果为自变量,建立HCC诊断综合预测模型.结果血清AFP,VTN,A1BG和AT-Ⅲ水平在HCC组,LC组,CH组和HC组之间差异具有统计学意义(F=1498.93,51.68,84.00,115.34,P<0.05).(1)HCC组和其他组相比,VTN水平差异无统计学意义(F=1.31),作为筛查指标相对效能较差;(2)单独检测时,AFP,HRG,A1BG和AT-Ⅲ曲线下面积(AUC)为0.878,0.579,0.712,0.801,VTN的AUC效能最低,无诊断价值,综合预测模型AUC为0.923,与AFP,A1BG和AT-Ⅲ比较,差异均有统计学意义(P<0.05);(3)AFP,A1BG和AT-Ⅲ单独诊断HCC的敏感性分别为70.00%,64.37%和61.25%,特异性分别为91.05%,74.74%和83.68%,AUC分别为0.878,0.712,0.801.综合预测模型的敏感性和特异性为85.00%和88.42%,AUC为0.923,与单独诊断比较,差异均有统计学意义(P<0.05).其预测HCC概率P=1/[1+exp(0.152-0.035 AFP-0.006 A1BG+0.021 AT-Ⅲ)],且具有较好的诊断效能.结论 AFP,A1BG,AT-Ⅲ联合检测效果优于AFP单独检测,能够提高肝癌早期诊断率.
To evaluate the value of combined detection of serumvitronectin （VTN）, alpha-1-B glycoprotein （AIBG）, antithrombin-Ⅲ （AT-Ⅲ）, and alpha fetoprotein （AFP） for early diagnosis of hepatocellular carcinoma （HCC）. METHODS ELISA was used to detect the concentrations of serum VTN, AIBG, and AT-Ⅲ in 160 patients with HCC, 70 patients with chronic hepatitis B （CHB）, 70 patients with liver cirrhosis （LC）, and 50 healthy controls （HC）, and electrochemical luminescence was used to detect serum concentration of AFP. The changes of VTN, AIBG, AT-Ⅲ, histidine-rich glycoprotein （HRG）, and AFP in different groups of subjects were compared. The sensitivity and specificity of HRG, AIBG, AFP, and AT-Ⅲ, alone or in different combinations, in the diagnosis of HCC were determined by receiver operating characteristic （ROC） curve analysis. Serum AFP, AIBG, and AT-Ⅲ were then used as independent variables to establish a comprehensive prediction model for HCC. RESULTS The levels of serum AFP, VTN, AIBG, and AT-Ⅲ were significantly different in the four groups （F = 1498.93, 51.68, 84.00, 115.34, P 〈 0.05）. There was no significant difference in the level of VTN between the HCC group and other groups （F = 1.31）, and its performance as a screening index was poor. The areas under the ROC curves （AUCs） of AFP, HRG, AIBG, and AT-Ⅲ were 0.878, 0.579, 0.712, and 0.801, respectively. The AUC of VTN was the lowest, suggesting that it has no diagnostic value. The AUC of the comprehensive prediction model was 0.923, which was significantly higher than those of AIBG and AT-Ⅲ （P 〈 0.05）. The sensitivities of AFP, AIBG, and AT-Ⅲ for the diagnosis of HCC were 70.00%, 64.37%, and 61.25%, respectively, the specificities were 91.05%, 74.74%, and 83.68%, respectively, and the AUCs were 0.878, 0.712 and 0.801, respectively. The sensitivity and specificityof the integrated prediction model were 85.00% and 88.42%, respectively. The AUC was 0.923, which was significantly different from the single diagnosis （P 〈 0.05）. The predictive equation was P = 1/[1＋exp （0.152-0.035 AFP-0.006 AIBG ＋ 0.021 AT-Ⅲ）], which had a good diagnostic performance. CONCLUSION Combined detection of serum AFP, AIBG, and AT-Ⅲ can improve the early diagnosis of HCC.
作者
范志娟
刘爽
张磊
田亚琼
刘树业
Zhi-Juan Fan;Shuang Liu;Lei Zhang;Ya-Qiong Tian;Shu- Ye Liu(Department of Clinical Laboratory, Tianjin Third Central Hospital, Tianjin 300170, China)
出处
《世界华人消化杂志》
CAS
2018年第14期842-848,共7页
World Chinese Journal of Digestology
关键词
α-1-B糖蛋白
抗凝血酶Ⅲ
甲胎蛋白
肝细胞肝癌
早期诊断
Alpha-l-B glycoprotein
Antithrombin-Ⅲ
Alphafetoprotein
Hepatocellular carcinoma
Early diagnosis
