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血清寡糖链检测对HBV相关肝细胞癌的诊断价值
Clinical value of serum Glycan-Test in the diagnosis of hepatitis B virus-related hepatocellular carcinoma
文章发布日期:2020年03月11日  来源:  作者:张立丽,金子铮,刘宁,等  点击次数:315次  下载次数:51次

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【摘要】:目的 评价寡糖链检测(G-Test)试剂盒(荧光毛细管电泳法)辅助诊断HBV相关肝细胞癌(HCC)的临床价值。方法 收集2017年8月-2018年6月就诊于北京佑安医院的患者血清样本310例,其中HBV相关HCC (HCC组)170例,乙型肝炎肝硬化(肝硬化组)50例,慢性乙型肝炎(肝炎组)85例,其他脏器恶性肿瘤(其他恶性肿瘤组)5例。检测血清寡糖链组分的相对浓度,计算并分析G-Test试剂盒在临床诊断中的灵敏度、特异度、总符合率和阳性预测值、阴性预测值,并与血清AFP进行方法学比较。非正态计量资料多组间比较采用Kruskal-Wallis H检验,进一步两两比较使用Dunn’s多重比较,计数资料两组间比较采用χ2检验。 利用受试者工作特征曲线(ROC曲线)对诊断效能进行分析, 利用logistic回归建立G-Test与AFP联合诊断模型,受试者工作特征曲线下面积(AUC)的比较采用Z检验。结果 HCC组患者G值[6.46(5.73~7.07)]明显高于肝炎组[3.38(2.85~4.18)]及肝硬化组[3.99(3.13~5.21)]患者(H值分别为107.9、104.2,P值均<0.001)。HCC组患者AFP的水平明显高于肝炎组患者[0.77(0.45~1.77)log10 ng/ml vs 0.58(0.41~0.89)log10 ng/ml,H=33.65,P=0.025]。G-Test的灵敏度83.53%,特异度为74.29%,总体符合率为79.36%,阳性预测值79.78%,阴性预测值78.79%。G-Test与AFP单独诊断的AUC分别为0.846与0.611,G-Test的AUC明显高于AFP(Z=5.795,P<0.001),G-Test联合AFP诊断的AUC为0.870,明显优于G-Test(Z=2.523,P=0.012)与AFP(Z=6.943,P<0.001)单独诊断效能。HCC早期与中晚期组间G-Test检出率均高于AFP>400 ng/ml检出率(χ2值分别为26.441、38.379,P值均<0.001)。 AFP分别以<20、<200、<400 ng/ml为阴性临界值,G-Test在AFP阴性的HCC患者中检出率分别为86.24%、85.93%、85.31%。结论 G-Test的灵敏度和特异度较好,具有辅助诊断HCC的临床应用价值,联合AFP诊断效能更好。
【Abstract】:Objective To investigate the clinical value of the oligosaccharide chain detection kit Glycan-Test (G-Test, fluorescent capillary electrophoresis) in assisting the diagnosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Methods A total of 310 serum samples were collected from the patients who attended Beijing YouAn Hospital from August 2017 to June 2018, among which there were 170 samples of HBV-related HCC (HCC group), 50 samples of hepatitis B cirrhosis (liver cirrhosis group), 85 samples of chronic hepatitis B (hepatitis group), and 5 samples of other malignant tumors of visceral organs. The relative concentration of serum oligosaccharide chain was measured, and the sensitivity, specificity, overall coincidence rate, positive predictive value, and negative predictive value of G-Test in clinical diagnosis were calculated and analyzed. A methodological comparison was performed for G-Test and serum alpha-fetoprotein (AFP). The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups, and the Dunn’s multiple comparison test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic (ROC) curve was used to evaluate diagnostic efficiency, and the logistic regression model was used to establish a combined diagnostic model of G-Test and AFP. The Z test was used for comparsion of area under ROC curve. Results The HCC group had a significantly higher level of G-Test than the hepatitis group [6.46 (5.73-7.07) vs 3.38 (2.85-4.18), H=107.9,P<0.001]and the liver cirrhosis group[6.46 (5.73-7.07) vs 3.99 (3.13-5.21), H=104.2,P<0.001]. The HCC group had a significantly higher AFP level than the hepatitis group [0.77 (0.45-1.77) log10 ng/ml vs 0.58 (0.41-0.89) log10 ng/ml, H=33.65,P = 0.025]. G-Test had a sensitivity of 83.53%, a specificity of 74.29%, an overall coincidence rate of 79.36%, a positive predictive value of 79.78%, and a negative predictive value of 78.79%. G-Test alone had a significantly larger AUC than AFP alone (0.846 vs 0.611, Z=5.795, P <0.001), and G-Test combined with AFP had an AUC of 0.870, which was significantly larger than that of G-Test alone (Z=2.523, P = 0.012) or AFP alone (Z=6.943, P<0.001). There were significant differences in the detection rates of G-Test and AFP between the early-stage group and the advanced group (χ2=26.441、38.379, all P<0.001). At the negative cut-off values of <20, <200, and <400 ng/ml for AFP, G-Test had a detection rate of 86.24%, 85.93%, and 85.31%, respectively, in HCC patients with negative AFP. Conclusion G-Test has good sensitivity and specificity and a certain clinical value in assisting the diagnosis of HCC, and G-Test combined with AFP has better diagnostic efficiency.
【关键字】:寡糖类; 甲胎蛋白类; 癌,肝细胞
【Key words】:oligosaccharides; alpha-fetoproteins; carcinoma,hepatocellular
【引证本文】:ZHANG LL, JIN ZZ, LIU N, et al. Clinical value of serum Glycan-Test in the diagnosis of hepatitis B virus-related hepatocellular carcinoma[J]. J Clin Hepatol, 2020, 36(4): 788-791. (in Chinese)
张立丽, 金子铮, 刘宁, 等. 血清寡糖链检测对HBV相关肝细胞癌的诊断价值[J]. 临床肝胆病杂志, 2020, 36(4): 788-791.

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