摘要
目的探讨血清磷脂酰肌醇蛋白聚糖3(GPC3)检测在原发性肝细胞癌(HCC)辅助诊断、疗效监测等方面的临床应用价值。方法选择2018年3月至2019年5月在复旦大学附属肿瘤医院病理诊断为HCC的患者166例作为实验组,以同医院体检中心健康者94名、良性肝病患者50例分别作为健康对照组和良性对照组,采用酶联免疫吸附试验(ELISA)法和电化学发光法分别检测血清GPC3和甲胎蛋白(AFP)含量[中位数(四分位数Q1,Q3)],利用Logistic回归分析GPC3联合AFP等指标在HCC中的诊断准确性。结果HCC患者组的血清GPC3含量为0.210(0.048,0.801)mg/L,明显高于健康对照组0.029(0.019,0.052)mg/L及良性对照组0.033(0.021,0.043)mg/L(Z=-7.69,P<0.001);谷草转氨酶(AST)(Z=-7.02)、谷丙转氨酶(ALT)(Z=-6.85)和AFP(Z=-8.36)在三组人群中均存在明显差异(P均<0.001);HCC患者的血清GPC3浓度与ALT(Z=-3.77)、AST(Z=-4.09)相关(P均<0.001)。通过ROC曲线确定GPC3的Cut‑off值0.077 mg/L后,血清GPC3联合AFP检测对HCC的灵敏度高达87.82%,特异性为77.86%,阳性预测值为82.53%,阴性预测值为84.29%。通过Logistic回归分析得到HCC‑GPC3相关模型,其ROC曲线下面积为0.882,总灵敏度为91.10%,总特异性为72.73%。进一步分析,HCC患者的术后血清GPC3含量0.454(0.019,0.286)mg/L较术前0.608(0.039,0.554)mg/L明显降低(Z=-7.32,P<0.001)。结论血清GPC3水平检测可应用于HCC的辅助诊断及疗效监测,联合GPC3及AFP可提高HCC的诊断效能。
Objective To investigate the clinical value of glypican‑3(GPC3)detection in the diagnosis and therapy‑monitoring of primary hepatocellular carcinoma(HCC).Methods From March 2018 to May 2019,the patients with HCC were enrolled as the experimental group(n=166)from Fudan University Shanghai Cancer Centre,while the specimens from health control group(n=94)and benign control group(n=50)were analyzed.The serum of GPC3 and alpha fetoprotein(AFP)levels were respectively detected by ELISA and chemiluminescence.GPC3 detections combined with AFP etc.in accuracy of HCC diagnosis were explored by using Logistic regression analysis.Results The serum GPC3 level in patients with HCC[0.210(0.048,0.801)mg/L][Median(quartile Q1,Q3)]was significantly higher than those in healthy controls[0.029(0.019,0.052)mg/L]and benign controls[0.033(0.021,0.043)mg/L](Z=-7.69,P<0.001).The serum levels of aspartate aminotransferase(AST),alanine aminotransferase(ALT)and AFP were significantly different among the three groups(Z=-7.02,-6.85,-8.36 respectively,P<0.001).Among the serological indicators,it was related to ALT and AST(Z=-3.77,-4.09 respectively,P<0.001).The Cut‑off level of GPC3 was determined as 0.077 mg/L by ROC curve.The sensitivity of the combined detection of serum GPC3 with AFP for HCC was up to 87.82%,the specificity was 77.86%,the negative predictive value was 84.29%,and the positive predictive value was 82.53%.The HCC‑GPC3 model was constructed by using Logistic regression analysis.The area under the ROC curve was 0.882,the total sensitivity was 91.10%,and the total specificity was 72.73%.Further analysis showed that the serum GPC3 of patients with HCC was significantly lower[0.454(0.019,0.286)mg/L]than that before surgery[0.608(0.039,0.554)mg/L](Z=-7.32,P<0.001).Conclusion The detection of serum GPC3 can be applied to aid diagnosis and therapy‑monitoring of HCC.The combination of GPC3 and AFP can improve the diagnostic efficiency of HCC.
作者
汤笑禹
王砚春
卢仁泉
郭林
Tang Xiaoyu;Wang Yanchun;Lu Renquan;Guo Lin(Department of Clinical Laboratory,Fudan University Shanghai Cancer Centre,Shanghai 200032,China;Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2020年第9期998-1002,共5页
Chinese Journal of Preventive Medicine
