血清AFP、CEA和CA199联合检测在老年丙肝相关肝硬化和肝癌诊断中的作用
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摘要
目的:探讨联合检测血清AFP、CEA和CA199在老年丙肝相关肝癌早期诊断中的临床价值。方法:采用电化学发光分析技术检测35例老年丙肝相关肝细胞癌、45例老年丙肝相关肝硬化患者和70例健康体检老年人对照组血清AFP、CEA和CA199水平,分析老年丙肝相关肝硬化和丙肝相关肝癌病变不同阶段血清AFP、CEA和CA199水平变化,绘制ROC曲线和计算曲线下面积(AUC)并评价各指标在老年丙肝相关肝癌诊断中的作用。结果:丙肝相关肝癌组和丙肝相关肝硬化组中AFP、CEA、CA199血清浓度水平均显著高于健康对照组(P<0.05)、肝癌组高于肝硬化组(P<0.05)。AFP、CEA和CA199在丙肝相关肝癌组的阳性表达率分别为68.6%、51.4%和62.9%,而三者联合检测诊断丙肝相关肝癌的阳性率提高至94.3%,联合检测阳性率在丙肝相关肝癌组、丙肝相关肝硬化组和对照组各组之间两两比较差异均具有统计学意义(P<0.05)。AFP、CEA和CA199三者联合检测的AUC为0.917,高于各单项检测的AUC(P<0.05),联合检测的诊断正确率提高至83.8%。结论:联合检测血清AFP、CEA和CA199水平可为临床诊断和鉴别诊断老年丙肝相关肝硬化与丙肝相关肝癌提供有效的参考,有助于提高丙肝相关肝癌早期诊断率。
Objective:To investigate the clinical value of combined detection of serum AFP,CEA and CA199 in the early diagnosis of Senile HCV-related hepatocellular carcinoma.Method:Electrochemical luminescence analysis technology was used to detect the serum AFP,CEA and CA199 levels in 45 cases of Senile HCV-related liver cirrhosis(HCV-Cirr),35 cases of Senile HCV-related Hepatocellular carcinoma(HCVHCC),and 70 cases of Senile healthy check-up as the control group,the changes of serum AFP,CEA and CA199 levels in different stages of HCV-Cirr and HCV-HCC in Senile were analysed.Plotted ROC curve and calculated the area under curve(AUC)to evaluate the role of each index in the diagnosis of Senile HCV-HCC.Result:The serum concentration levels of AFP,CEA and CA199 in HCV-HCC group and HCV-Cirr group were significantly higher than those in the healthy control group(P<0.05),HCV-HCC group was higher than HCV-Cirr group(P<0.05).The positive expression rates of AFP,CEA and CA199 in HCV-HCC group were respectively 68.6%、51.4% and 62.9%.The positive rate of combined detection of three markers in diagnosis of HCV-HCC was increased to 94.3%.The positive rate of combined detection in HCV-HCC group,HCV-Cirr group and control group between any two groups showed significant statistical different(P<0.05).The AUC of the combined detection of AFP,CEA and CA199 was 0.917,which was higher than the AUC of each single test(P<0.05).The diagnostic accuracy of combined detection was increased to 83.8%.Conclusion:The combined detection of serum AFP,CEA and CA199 levels can provide an effective reference for the clinical diagnosis and identification of Senile HCV-Cirr and HCVHCC,which can help to improve the early diagnosis rate of HCV-HCC.
Objective:To investigate the clinical value of combined detection of serum AFP,CEA and CA199 in the early diagnosis of Senile HCV-related hepatocellular carcinoma.Method:Electrochemical luminescence analysis technology was used to detect the serum AFP,CEA and CA199 levels in 45 cases of Senile HCV-related liver cirrhosis(HCV-Cirr),35 cases of Senile HCV-related Hepatocellular carcinoma(HCVHCC),and 70 cases of Senile healthy check-up as the control group,the changes of serum AFP,CEA and CA199 levels in different stages of HCV-Cirr and HCV-HCC in Senile were analysed.Plotted ROC curve and calculated the area under curve(AUC)to evaluate the role of each index in the diagnosis of Senile HCV-HCC.Result:The serum concentration levels of AFP,CEA and CA199 in HCV-HCC group and HCV-Cirr group were significantly higher than those in the healthy control group(P<0.05),HCV-HCC group was higher than HCV-Cirr group(P<0.05).The positive expression rates of AFP,CEA and CA199 in HCV-HCC group were respectively 68.6%、51.4% and 62.9%.The positive rate of combined detection of three markers in diagnosis of HCV-HCC was increased to 94.3%.The positive rate of combined detection in HCV-HCC group,HCV-Cirr group and control group between any two groups showed significant statistical different(P<0.05).The AUC of the combined detection of AFP,CEA and CA199 was 0.917,which was higher than the AUC of each single test(P<0.05).The diagnostic accuracy of combined detection was increased to 83.8%.Conclusion:The combined detection of serum AFP,CEA and CA199 levels can provide an effective reference for the clinical diagnosis and identification of Senile HCV-Cirr and HCVHCC,which can help to improve the early diagnosis rate of HCV-HCC.
引文
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[11]羊文芳,郑文雯,苏显都,等.肿瘤标记物在肝癌患者血清中的表达及其诊断价值[J].解放军医学院学报,2016,37(9):976-978.
[12]Zekri A R,Youssef A S,Bakr Y M,et al.Serum biomarkers for early detection of hepatocellular carcinoma associated with HCV infection in Egyptian patients[J].Asian Pac J Cancer Prev,2015,16(3):1281-1287.
[13]Minami T,Tateishi R,Kondo M,et al.Serum AlphaFetoprotein Has High Specificity for the Early Detection of Hepatocellular Carcinoma After Hepatitis C Virus Eradication in Patients[J].Medicine(Baltimore),2015,94(23):e901.
[14]Chun S,Rhie S Y,Ki C S,et al.Evaluation of alphafetoprotein as a screening marker for hepatocellular carcinoma in hepatitis prevalent areas[J].Ann Hepatol,2015,14(6):882-888.
[15]Axley P,Ahmed Z,Ravi S,et al.Hepatitis C Virus and Hepatocellular Carcinoma:A Narrative Review[J].J Clin Transl Hepatol,2018,6(1):79-84.
[16]Nojiri S,Fujiwara K,Shinkai N,et al.Evaluation of hepatocellular carcinoma development in patients with chronic hepatitis C by EOB-MRI[J].World J Hepatol,2014,6(12):930-938.
[17]Kitagawa Y,Iwai M,Muramatsu A,et al.Immunohistochemical localization of CEA,CA19-9 and DU-PAN-2 in hepatitis Cvirus-infected liver tissues[J].Histopathology,2001,40(5):472-479.
[2]Petruzziello A.Epidemiology of Hepatitis B Virus(HBV)and Hepatitis C Virus(HCV)Related Hepatocellular Carcinoma[J].Open Virol J,2018,12:26-32.
[3]Schietroma I,Scheri G C,Pinacchio C,et al.Hepatitis C Virus and Hepatocellular Carcinoma:Pathogenetic Mechanisms and Impact of Direct-Acting Antivirals[J].Open Virol J,2018,12:16-25.
[4]Kanwal F,Hoang T,Kramer J R,et al.Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection[J].Gastroenterology,2011,140(4):1182-1188.
[5]中华医学会肝病学分会,中华医学会感染病学分会.丙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1976-1979.
[6]Yamashita T,Honda M,Kaneko S.Molecular mechanisms of hepatocarcinogenesis in chronic hepatitis C virus infection[J].J Gastroenterol Hepatol,2011,26(6):960-964.
[7]Zhao Y J,Ju Q,Li G C.Tumor markers for hepatocellular carcinoma[J].Mol Clin Oncol,2013,1(4):593-598.
[8]El-Abd N E,Fawzy N A,El-Sheikh S M,et al.Circulating miRNA-122,miRNA-199a,and miRNA-16 as Biomarkers for Early Detection of Hepatocellular Carcinoma in Egyptian Patients with Chronic Hepatitis C Virus Infection[J].Mol Diagn Ther,2015,19(4):213-220.
[9]Takeuchi Y,Ikeda F,Osawa T,et al.Alpha-fetoprotein before and after pegylated interferon therapy for predicting hepatocellular carcinoma development[J].World J Hepatol,2015,7(19):2220-2228.
[10]Zekri A R,Youssef A S,Bakr Y M,et al.Early detection of hepatocellular carcinoma co-occurring with hepatitis C virus infection:A mathematical model[J].World J Gastroenterol,2016,22(16):4168-4182.
[11]羊文芳,郑文雯,苏显都,等.肿瘤标记物在肝癌患者血清中的表达及其诊断价值[J].解放军医学院学报,2016,37(9):976-978.
[12]Zekri A R,Youssef A S,Bakr Y M,et al.Serum biomarkers for early detection of hepatocellular carcinoma associated with HCV infection in Egyptian patients[J].Asian Pac J Cancer Prev,2015,16(3):1281-1287.
[13]Minami T,Tateishi R,Kondo M,et al.Serum AlphaFetoprotein Has High Specificity for the Early Detection of Hepatocellular Carcinoma After Hepatitis C Virus Eradication in Patients[J].Medicine(Baltimore),2015,94(23):e901.
[14]Chun S,Rhie S Y,Ki C S,et al.Evaluation of alphafetoprotein as a screening marker for hepatocellular carcinoma in hepatitis prevalent areas[J].Ann Hepatol,2015,14(6):882-888.
[15]Axley P,Ahmed Z,Ravi S,et al.Hepatitis C Virus and Hepatocellular Carcinoma:A Narrative Review[J].J Clin Transl Hepatol,2018,6(1):79-84.
[16]Nojiri S,Fujiwara K,Shinkai N,et al.Evaluation of hepatocellular carcinoma development in patients with chronic hepatitis C by EOB-MRI[J].World J Hepatol,2014,6(12):930-938.
[17]Kitagawa Y,Iwai M,Muramatsu A,et al.Immunohistochemical localization of CEA,CA19-9 and DU-PAN-2 in hepatitis Cvirus-infected liver tissues[J].Histopathology,2001,40(5):472-479.