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AFP和AFP-L3%联合检测在肝细胞癌诊断中的应用价值
Value of combined measurement of alpha-fetoprotein and alpha-fetoprotein L3% in the diagnosis of hepatocellular carcinoma
文章发布日期:2019年06月14日  来源:  作者:关贵文,姚明解,钱相君,等  点击次数:234次  下载次数:64次

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【摘要】:目的探究AFP联合AFP-L3%检测在肝细胞癌诊断中的应用价值。方法回顾性收集2010年1月-2017年12月在解放军总医院第五医学中心就诊的1208例慢性肝炎患者、1967例肝硬化患者和1569例肝细胞癌患者的血清学指标及临床资料。分析各组患者血清AFP及AFP-L3%的分布情况,比较AFP、AFP-L3%单独及两者联合诊断肝癌的灵敏度、特异度及受试者工作特征曲线下面积(AUC),并分析AFP和AFP-L3、AFP-L3%的相关性。计量资料多组间比较采用单因素方差分析或Kruskal-Wallis H检验,计数资料组间比较采用χ2检验。计量资料的相关性分析采用Spearman秩相关。AUC之间的比较采用Delong检验。采用logistic回归建立AFP-L3%及AFP联合诊断肝癌的模型。结果肝癌组AFP和AFP-L3水平均显著高于肝硬化组和慢性肝炎组(H值分别为1107.3、1076.9,P值均<0.01)。肝癌组AFP-L3%阳性率为30.9%,显著高于肝硬化(3.0%)及慢性肝炎组(2.8%)(χ2=768.5,P<0.01)。肝癌组AFP-L3%水平为3.3(0~13.4)%,显著高于肝硬化(0)及慢性肝炎组(0)(H=1034.1,P<001)。相关分析结果显示血清AFP与AFP-L3水平显著相关(r=0.91,P<0.01),但AFP-L3%与AFP则无相关性(r=0.04,P>0.05)。在特异度相同的情况下,AFP联合AFP-L3%诊断肝癌的灵敏度显著高于AFP(26.6% vs 18.4%,P<0.01)或AFP-L3%单用(36.6% vs 30.9%,P<0.01)。亚组分析显示,对于AFP≥10 μg/L的样本,联合诊断肝癌的AUC显著高于AFP单用(0.745 vs 0.701,P<0.01);在肿瘤直径>2 cm或乙型肝炎相关肝癌中,联合检测的灵敏度显著高于AFP单用(27.6% vs 18.0%,27.7% vs 19.1%,P值均<0.01)或AFP-L3% 单用(37.0% vs 30.3%,36.9% vs 31.8%,P值均<0.01)。但在肿瘤直径≤2 cm以及非乙型肝炎相关肝癌亚组中,联合检测诊断肝癌的灵敏度与单用AFP或AFP-L3%差异均无统计学意义(P值均>0.05)。结论AFP联合AFP-L3%能显著提高肝癌诊断的灵敏度,对乙型肝炎相关肝癌和肿瘤直径>2 cm肝癌的辅助诊断具有更好的临床应用价值。
【Abstract】:ObjectiveTo investigate the value of combined measurement of alpha-fetoprotein (AFP) and AFP-L3% in the diagnosis of hepatocellular carcinoma (HCC). MethodsA retrospective analysis was performed for serological parameters and clinical data of 1208 patients with chronic hepatitis, 1967 patients with liver cirrhosis, and 1569 patients with primary HCC who attended The Fifth Medical Center of Chinese PLA General Hospital from January 2010 to December 2017. The distribution of serum AFP and AFP-L3% was analyzed, and AFP alone, AFP-L3% alone, and AFP combined with AFP-L3% were compared in terms of sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). The correlation of AFP with AFP-L3 level and AFP-L3% was also analyzed. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used for correlation analysis of continuous data, the Delong test was used for comparison of AUC, and logistic regression was used to establish the model of AFP combined with AFP-L3% for the diagnosis of HCC. ResultsThe HCC group had significantly higher serum levels of AFP and AFP-L3 than the liver cirrhosis group and the chronic hepatitis group (H=1107.3 and 1076.9, both P<0.01). The HCC group had a significantly higher positive rate of AFP-L3% than the liver cirrhosis group and the chronic hepatitis group (30.9% vs 3.0%/2.8%, P<0.01). The HCC group had a significantly higher level of AFP-L3 than the liver cirrhosis group and the chronic hepatitis group (3.3(0-13.4)% vs 0/0, H=1034.1, P<001). The correlation analysis showed that serum AFP was significantly correlated with AFP-L3 level (r=0.91, P<0.01), and there was no correlation between AFP-L3% and AFP (r=0.04, P>0.05). With specificity remaining the same, AFP combined with AFP-L3% had a significantly higher sensitivity in the diagnosis of HCC than AFP alone (26.6% vs 18.4%, P<0.01) or AFP-L3% alone (36.6% vs 30.9%, P<0.01). The subgroup analysis showed that for the samples with AFP ≥10 μg/L, AFP combined with AFP-L3% had a significantly higher AUC in the diagnosis of HCC than AFP alone (0.745 vs 0.701, P<0.01); for the tumor with a diameter of >2 cm or hepatitis B-related liver cancer, AFP combined with AFP-L3% had a significantly higher sensitivity than AFP alone (27.6% vs 18.0%/27.7% vs 19.1%, both P<0.01) or AFP-L3% alone (37.0% vs 30.3%/36.9% vs 31.8%, both P<0.01). For the group with a tumor diameter of ≤2 cm and the group without hepatitis B-related liver cancer, there was no significant difference in sensitivity between AFP combined with AFP-L3% and AFP or AFP-L3% alone in the diagnosis of HCC (all P>0.05). ConclusionAFP combined with AFP-L3% can significantly improve the sensitivity of HCC diagnosis and has a good clinical value in the diagnosis of hepatitis B-related liver cancer and liver cancer with a tumor diameter of >2 cm.
【关键字】:癌,肝细胞;甲胎蛋白类;诊断;曲线下面积
【Key words】:carcinoma, hepatocellular; alpha-fetoproteins; diagnosis; area under curve
【引证本文】:GUAN GW, YAO MJ, QIAN XJ, et al. Value of combined measurement of alpha-fetoprotein and alpha-fetoprotein L3% in the diagnosis of hepatocellular carcinoma[J]. J Clin Hepatol, 2019, 35(7): 1514-1519. (in Chinese)
关贵文,姚明解,钱相君,等. AFP和AFP-L3%联合检测在肝细胞癌诊断中的应用价值[J]. 临床肝胆病杂志, 2019, 35(7): 1514-1519.

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