血清异常凝血酶原复合物、甲胎蛋白、铁蛋白检测对HBV相关肝细胞癌的辅助诊断意义

文君; 李嘉; 王春妍; 马莹

doi:10.3969/j.issn.1001-5256.2017.09.020

血清异常凝血酶原复合物、甲胎蛋白、铁蛋白检测对HBV相关肝细胞癌的辅助诊断意义

DOI: 10.3969/j.issn.1001-5256.2017.09.020

天津市第二人民医院肝病Ⅱ科

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中图分类号: R512.62;R735.7
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出版历程
- 收稿日期: 2017-03-20
- 出版日期: 2017-09-20

Value of serum PIVKA-Ⅱ, alpha-fetoprotein, and ferritin in assisting the diagnosis of HBV-related hepatocellular carcinoma

Second Department of Hepatology, Tianjin Second People's Hospital

摘要

摘要: 目的探讨血清异常凝血酶原复合物（PIVKA-Ⅱ）、甲胎蛋白（AFP）、铁蛋白（FER）单项及联合检测在HBV相关肝细胞癌（HCC）辅助诊断中的意义。方法收集2016年6月-2017年2月于天津市第二人民医院住院的40例HBV相关HCC、41例乙型肝炎肝硬化、44例慢性乙型肝炎患者及36例健康体检者的血清,并检测PIVKA-Ⅱ、AFP、FER水平,分别分析三者单独及联合检测诊断HBV相关HCC的受试者工作曲线下面积（AUC）、敏感度和特异度。非正态分布的计量资料组间比较采用非参数KruskalWallis H检验,进一步两两比较采用Mann-Whitney U检验。采用二元logistic进行逐步回归分析产生三项指标联合预测概率的新变量pre。结果血清AFP及PIVKA-Ⅱ水平在乙型肝炎肝硬化、慢性乙型肝炎、HBV相关HCC及健康对照组间的差异均具有统计学意义（χ2值分别为51.446、59.613,P值均<0.001）。AFP水平在HBV相关HCC组显著高于乙型肝炎肝硬化组、慢性乙型肝炎组及健康对照组（Z值分别为-4.609、-6.026、-6.031,P值...
- 癌,肝细胞 /
- 铁蛋白质类 /
- 甲胎蛋白类 /
- 异常凝血酶原 /
- 诊断
Abstract: Objective To investigate the value of serum PIVKA-Ⅱ, alpha-fetoprotein ( AFP) , and ferritin ( FER) measured alone or in combination in assisting the diagnosis of HBV-related hepatocellular carcinoma ( HCC) . Methods A total of 40 patients with hepatitis B virus ( HBV) -related HCC, 41 patients with liver cirrhosis after hepatitis B, 44 patients with chronic hepatitis B ( CHB) , and 36 controls who underwent physical examination were enrolled. Their serum samples were collected and the serum levels of PIVKA-Ⅱ, AFP, and FER were measured. The area under the ROC curve ( AUC) , sensitivity, and specificity of PIVKA-Ⅱ, AFP, and FER measured alone or in combination in the diagnosis of HBV-related HCC were analyzed. The non-parametric Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between groups, and the Mann-Whitney U test was used for further comparison between two groups. A binary logistic stepwise regression analysis was used to determine the new variable pre of predicted probability of combined measurement of these three indices. Results There were significant differences in the serum levels of AFP and PIVKA-Ⅱ between the liver cirrhosis group, CHB group, HBV-related HCC group, and healthy control group ( χ2= 51. 446 and 59. 613, both P < 0. 001) . The HBV-related HCC group had a significantly higher serum level of AFP than the liver cirrhosis group, CHB group, and healthy control group ( Z =-4. 609, -6. 026, and-6. 031, all P < 0. 001) , and the liver cirrhosis group also had a significantly higher serum level of AFP than the healthy control group ( Z =-2. 30, P = 0. 021) . The HBV-related HCC group had a significantly higher serum level of PIVKA-Ⅱ than the liver cirrhosis group, CHB group, and healthy control group ( Z =-6. 080, -6. 595, and-5. 608, all P < 0. 001) , and the CHB group had a significantly higher serum level of PIVKA-Ⅱ than the healthy control group ( Z =-2. 153, P = 0. 031) . The HBV-related HCC group had a significantly higher serum level of FER than the CHB group ( Z =-2. 177, P = 0. 029) . When measured alone, AFP had the highest sensitivity in the diagnosis of HBV-related HCC ( 79. 49%) , and FER had the highest specificity ( 94. 28%) . When any two of these indices were measured, PIVKA-Ⅱ/AFP had the highest sensitivity ( 89. 74%) , and FER + AFP and FER + PIVKA-Ⅱ had a high specificity ( 97. 14%) . FER/AFP/PIVKA had a sensitivity of 92. 31% and the combined measurement of FER, AFP, and PIVKA-Ⅱhad a specificity of 97. 14%. Conclusion Combined measurement of PIVKA-Ⅱ, AFP, and FER can improve the sensitivity and specificity of single measurement. Serum PIVKA-Ⅱ and AFP have a high clinical value in the diagnosis of HCC; single measurement can well assist the diagnosis, and combined measurement does not increase the diagnostic rate.
- carcinoma, hepatocellular /
- ferritins /
- alpha-fetoproteins /
- protein induced by vitamin K absence or antagonist-Ⅱ /
- diagnosis

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