血清异常凝血酶原在原发性肝癌诊断中的作用
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摘要
目的探讨血清异常凝血酶原(PIVKA-Ⅱ)在原发性肝癌诊断中的作用。方法采用化学发光法检测原发性肝癌及肝硬化患者血清PIVKA-Ⅱ和甲胎蛋白(AFP)水平,并计算PIVKA-Ⅱ诊断原发性肝癌的敏感性、特异性。结果原发性肝癌患者血清PIVKA-Ⅱ水平[805.00(63.25,13 531.75)mAU·mL~(-1)]明显高于肝硬化组[19.00(14.00,26.00)mAU·mL~(-1)],差异有统计学意义(P<0.05)。PIVKA-Ⅱ的受试者工作特征曲线(ROC)曲线下面积0.917,以36.00 mAU·mL~(-1)作为cut-off值,PIVKA-Ⅱ诊断原发性肝癌的敏感性和特异性分别为82%和94%。在40例AFP阴性的原发性肝癌患者中,PIVKA-Ⅱ的ROC曲线下面积为0.850,当cut-off值为36.50 mAU·mL~(-1)时,PIVKA-Ⅱ诊断原发性肝癌的敏感性和特异性分别为68%和94%。结论 PIVKA-Ⅱ可作为临床诊断原发性肝癌的肿瘤标志物,为临床上该疾病的诊断提供可靠的理论依据。
Objective To investigate the role of serum abnormal prothrombin(PIVKA-Ⅱ) in the diagnosis of primary hepatocellular carcinoma.Methods Detection of serum PIVKA-Ⅱ and alpha-fetoprotein(AFP) levels in patients with primary hepatocellular carcinoma and cirrhosis by chemiluminescence. The sensitivity and specificity of PIVKA-Ⅱ for diagnosis of primary hepatocellular carcinoma were calculated.Results The serum PIVKA-Ⅱ level in the primary hepatocellular carcinoma group [805.00(63.25,13 531.75)mAU·mL~(-1)] was significantly higher than that in the cirrhosis group[19.00(14.00,26.00)mAU·mL~(-1),P<0.05]. The area under curve of receiver operating characteristic(ROC) curve of PIVKA-Ⅱ was 0.917,at 36.00 mAU·mL~(-1) as the cut-off value, the sensitivity and specificity of PIVKA-Ⅱ for the diagnosis of primary hepatocellular carcinoma were 82% and 94%, respectively. In the 40 patients with AFP-negative primary hepatocellular carcinoma, the area under curve of ROC curve of PIVKA-Ⅱ was 0.850. When the cut-off value was 36.50 mAU·mL~(-1), the sensitivity and specificity of PIVKA-Ⅱ in the diagnosis of primary hepatocellular carcinoma were 68% and 94%, respectively.Conclusion PIVKA-Ⅱ can be used as a tumor marker for clinical diagnosis of primary hepatocellular carcinoma, providing a reliable theoretical basis for the diagnosis of this disease.
Objective To investigate the role of serum abnormal prothrombin(PIVKA-Ⅱ) in the diagnosis of primary hepatocellular carcinoma.Methods Detection of serum PIVKA-Ⅱ and alpha-fetoprotein(AFP) levels in patients with primary hepatocellular carcinoma and cirrhosis by chemiluminescence. The sensitivity and specificity of PIVKA-Ⅱ for diagnosis of primary hepatocellular carcinoma were calculated.Results The serum PIVKA-Ⅱ level in the primary hepatocellular carcinoma group [805.00(63.25,13 531.75)mAU·mL~(-1)] was significantly higher than that in the cirrhosis group[19.00(14.00,26.00)mAU·mL~(-1),P<0.05]. The area under curve of receiver operating characteristic(ROC) curve of PIVKA-Ⅱ was 0.917,at 36.00 mAU·mL~(-1) as the cut-off value, the sensitivity and specificity of PIVKA-Ⅱ for the diagnosis of primary hepatocellular carcinoma were 82% and 94%, respectively. In the 40 patients with AFP-negative primary hepatocellular carcinoma, the area under curve of ROC curve of PIVKA-Ⅱ was 0.850. When the cut-off value was 36.50 mAU·mL~(-1), the sensitivity and specificity of PIVKA-Ⅱ in the diagnosis of primary hepatocellular carcinoma were 68% and 94%, respectively.Conclusion PIVKA-Ⅱ can be used as a tumor marker for clinical diagnosis of primary hepatocellular carcinoma, providing a reliable theoretical basis for the diagnosis of this disease.
引文
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[8] 井沆,武红权,冉龙艳,等.血清异常凝血酶原联合甲胎蛋白检测对原发性肝癌的早期诊断价值[J].贵州医科大学学报,2018,43(9):37-40.
[9] 徐万菊,赵莉,马万山.甲胎蛋白异质体与高尔基体蛋白73在肝细胞癌诊断中的应用进展及展望[J].医学检验与临床,2010,21(1):70-71.
[10] XING H,YAN C,CHENG L,et al.Clinical application of protein induced by vitamin K antagonist-Ⅱ as a biomarker in hepatocellular carcinoma [J].Tumour Biol,2016,37(12):15447-15456.
[11] HUANG S,JIANG F,WANG Y,et al.Diagnostic performance of tumor markers AFP and PIVKA-Ⅱ in Chinese hepatocellular carcinoma patients[J].Tumour Biol,2017,39(6):101042831770576.
[2] 王菊英,陈丽萍,雷静月.血清AFP、CEA、SF、AFU联检在肝癌诊断中的意义[J].放射免疫学杂志,2007,20(1):48-49.
[3] 张春晨,董勤.原发性肝癌发病相关因素研究进展[J].世界最新医学信息文摘,2015(75):62-65.
[4] 中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].中华肝脏病杂志,2012,20(6):929-946.
[5] ZINKIN NT,GRALL F,BHASKAR K,et al.Serum proteomics and biomarkers in hepatocellular carcinoma and chronic liver disease[J].Clin Cancer Res,2008,14(2):470-477.
[6] LIEBMAN HA,FURIE BC,TONG MJ,et al.Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma[J].N Engl J Med,1984,310(22):1427-1431.
[7] 濮珏彪,王学锋,彭奕冰.血清异常凝血酶原检测在原发性肝癌临床诊断中的应用[J].检验医学,2014,29(3):270-273.
[8] 井沆,武红权,冉龙艳,等.血清异常凝血酶原联合甲胎蛋白检测对原发性肝癌的早期诊断价值[J].贵州医科大学学报,2018,43(9):37-40.
[9] 徐万菊,赵莉,马万山.甲胎蛋白异质体与高尔基体蛋白73在肝细胞癌诊断中的应用进展及展望[J].医学检验与临床,2010,21(1):70-71.
[10] XING H,YAN C,CHENG L,et al.Clinical application of protein induced by vitamin K antagonist-Ⅱ as a biomarker in hepatocellular carcinoma [J].Tumour Biol,2016,37(12):15447-15456.
[11] HUANG S,JIANG F,WANG Y,et al.Diagnostic performance of tumor markers AFP and PIVKA-Ⅱ in Chinese hepatocellular carcinoma patients[J].Tumour Biol,2017,39(6):101042831770576.