异常凝血酶原(PIVKA-Ⅱ)和甲胎蛋白在原发性肝癌中的诊断价值
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摘要
目的探讨异常凝血酶原(PIVKA-Ⅱ)和甲胎蛋白(AFP)在原发性肝癌(PHC)中的诊断价值。方法回顾性分析108例PHC、100例肝硬化、89例慢性肝炎、76例继发性肝癌及84例健康体检者的临床资料,所有研究对象均检测血清PIVKA-Ⅱ与AFP水平。比较各组研究对象血清PIVKA-Ⅱ与AFP水平,并采用受试者工作特征(ROC)曲线评价PIVKA-Ⅱ及AFP对PHC的诊断效能。结果 PHC患者PIVKA-Ⅱ与AFP水平均高于非PHC肝病患者及健康体检者(均P <0. 05),且中晚期PHC患者PIVKA-Ⅱ与AFP水平均高于早期PHC患者(均P <0. 05)。不同病因PHC患者AFP水平差异无统计学意义(P> 0. 05),但肝炎合并酒精性PHC患者PIVKA-Ⅱ水平均低于病毒性肝炎性PHC与酒精性PHC患者(均P <0. 05),病毒性肝炎性PHC与酒精性PHC患者PIVKA-Ⅱ水平差异无统计学意义(P> 0. 05)。PIVKA-Ⅱ、AFP、PIVKA-Ⅱ联合AFP诊断PHC的ROC曲线下面积分别为0. 928、0. 871、0. 963,PIVKA-Ⅱ联合AFP诊断PHC的曲线下面积大于PIVKA-Ⅱ及AFP(P <0. 05)。结论 PIVKA-Ⅱ联合AFP检测在PHC中具有较高的诊断价值。
Objective To investigate the diagnostic value of abnormal prothrombin[protein induced by vitamin K absence or antagonist Ⅱ( PIVKA-Ⅱ) ] and alpha-fetoprotein( AFP) in primary hepatic carcinoma( PHC). Methods The clinical data of 108 patients with PHC,100 patients with cirrhosis,89 patients with chronic hepatitis,76 patients with secondary hepatocellular carcinoma and84 healthy persons undergoing a check-up were analyzed retrospectively. The serum levels of PIVKA-Ⅱ and AFP of the subjects were compared among all groups. The diagnostic efficiency of PIVKA-Ⅱ and AFP for PHC was evaluated by the receiver operating characteristic( ROC) curve as well. Results The levels of PIVKA-Ⅱ and AFP in the patients with PHC were higher than those in the patients with liver disease but without PHC or in the healthy subjects( all P < 0. 05),and the levels of PIVKA-Ⅱ and AFP in the patients with advanced PHC were higher than those in the patients with early PHC( all P < 0. 05). There was no statistically significant difference in the AFP level among the PHC patients with different etiologies( P > 0. 05),but the PIVKA-Ⅱ level in the hepatitis patients complicated with alcoholic PHC was lower than that in the patients with viral hepatitis PHC or alcoholic PHC( all P < 0. 05),there was no statistically significant difference in the PIVKA-Ⅱlevel between the patients with viral hepatitis PHC and the patients with alcoholic PHC( P > 0. 05). The areas of ROC curve of PIVKA-Ⅱ,AFP and their combination for diagnosing PHC were 0. 928,0. 871 and 0. 963 respectively,and the area of PIVKA-Ⅱcombined with AFP for diagnosing PHC was greater than that of PIVKA-Ⅱ or AFP( P < 0. 05). Conclusion The combined detection of PIVKA-Ⅱ and AFP has a higher diagnostic value for PHC.
Objective To investigate the diagnostic value of abnormal prothrombin[protein induced by vitamin K absence or antagonist Ⅱ( PIVKA-Ⅱ) ] and alpha-fetoprotein( AFP) in primary hepatic carcinoma( PHC). Methods The clinical data of 108 patients with PHC,100 patients with cirrhosis,89 patients with chronic hepatitis,76 patients with secondary hepatocellular carcinoma and84 healthy persons undergoing a check-up were analyzed retrospectively. The serum levels of PIVKA-Ⅱ and AFP of the subjects were compared among all groups. The diagnostic efficiency of PIVKA-Ⅱ and AFP for PHC was evaluated by the receiver operating characteristic( ROC) curve as well. Results The levels of PIVKA-Ⅱ and AFP in the patients with PHC were higher than those in the patients with liver disease but without PHC or in the healthy subjects( all P < 0. 05),and the levels of PIVKA-Ⅱ and AFP in the patients with advanced PHC were higher than those in the patients with early PHC( all P < 0. 05). There was no statistically significant difference in the AFP level among the PHC patients with different etiologies( P > 0. 05),but the PIVKA-Ⅱ level in the hepatitis patients complicated with alcoholic PHC was lower than that in the patients with viral hepatitis PHC or alcoholic PHC( all P < 0. 05),there was no statistically significant difference in the PIVKA-Ⅱlevel between the patients with viral hepatitis PHC and the patients with alcoholic PHC( P > 0. 05). The areas of ROC curve of PIVKA-Ⅱ,AFP and their combination for diagnosing PHC were 0. 928,0. 871 and 0. 963 respectively,and the area of PIVKA-Ⅱcombined with AFP for diagnosing PHC was greater than that of PIVKA-Ⅱ or AFP( P < 0. 05). Conclusion The combined detection of PIVKA-Ⅱ and AFP has a higher diagnostic value for PHC.
引文
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[20] Saitta C,Raffa G,Alibrandi A,et al. PIVKA-Ⅱis a useful tool for diagnostic characterization of ultrasound-detected liver nodules in cirrhotic patients[J]. Medicine(Baltimore),2017,96(26):e7266.
[21] Kudo M,Izumi N,Kokudo N,et al. Management of hepatocellular carcinoma in Japan:Consensus-Based Clinical Practice Guidelines proposed by the Japan Society of Hepatology(JSH)2010 updated version[J]. Dig Dis,2011,29(3):339-364.
[2] Hu B,Tian X,Sun J,et al. Evaluation of individual and combined applications of serum biomarkers for diagnosis of hepatocellular carcinoma:a meta-analysis[J]. Int J Mol Sci,2013,14(12):23 559-23 580.
[3] Seo SI,Kim HS,Kim WJ,et al. Diagnostic value of PIVKA-Ⅱand alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma[J]. World J Gastroenterol,2015,21(13):3 928-3 935.
[4] PotéN,Cauchy F,Albuquerque M,et al. Performance of PIVKA-Ⅱfor early hepatocellular carcinoma diagnosis and prediction of microvascular invasion[J]. J Hepatol,2015,62(4):848-854.
[5] Gentile I,Buonomo AR,Scotto R,et al. Diagnostic Accuracy of PIVKA-Ⅱ,Alpha-Fetoprotein and a Combination of both in Diagnosis of Hepatocellular Carcinoma in Patients Affected by Chronic HCV Infection[J]. In Vivo,2017,31(4):695-700.
[6] Ricco G,Cavallone D,Cosma C,et al. Impact of etiology of chronic liver disease on hepatocellular carcinoma biomarkers[J]. Cancer Biomark,2018,21(3):603-612.
[7] Ertle JM,Heider D,Wichert M,et al. A combination ofα-fetoprotein and des-γ-carboxy prothrombin is superior in detection of hepatocellular carcinoma[J]. Digestion,2013,87(2):121-131.
[8] Benson AB 3rd,D'Angelica MI,Abbott DE,et al. NCCN Guidelines Insights:Hepatobiliary Cancers,Version 1. 2017[J]. J Natl Compr Canc Netw,2017,15(5):563-573.
[9]杜旋.原发性肝癌TACE术前后甲胎蛋白的变化情况与预后的关系[D].南宁:广西医科大学,2017.
[10]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):705-720.
[11]王贵强,王福生,成军,等.慢性乙型肝炎防治指南(2015年版)[J].中华实验和临床感染病杂志(电子版),2015,9(5):570-589.
[12]陈红松,窦晓光,段钟平,等.丙型肝炎防治指南(2015年更新版)[J].临床肝胆病杂志,2015,31(12):1 961-1 979.
[13]葛均波,徐永健.内科学[M]. 8版.北京:人民卫生出版社,2014:424-425.
[14]李兰娟,任红.传染病学[M]. 8版.北京:人民卫生出版社,2014:34-36.
[15]张岩明.血清GPC3和HSP70检测在乙肝相关肝癌诊断中的应用价值[J].中国地方病防治杂志,2017,32(7):835.
[16]刘宓,钟银雪,王伟,等.血清异常凝血酶原在肝细胞癌诊断中的疗效分析[J].中国现代医学杂志,2017,27(29):90-93.
[17] Wang X,Zhang W,Liu Y,et al. Diagnostic value of prothrombin induced by the absence of vitamin K or antagonist-Ⅱ(PIVKA-Ⅱ)for early stage HBV related hepatocellular carcinoma[J].Infect Agent Cancer,2017,12(1):47.
[18] Miyakawa T,Kajiwara Y,Shirahata A,et al. Vitamin K contents in liver tissue of hepatocellular carcinoma patients[J]. Jpn J Cancer Res,2000,91(1):68-74.
[19] Park SJ,Jang JY,Jeong SW,et al. Usefulness of AFP,AFP-L3,and PIVKA-Ⅱ,and their combinations in diagnosing hepatocellular carcinoma[J]. Medicine(Baltimore),2017,96(11):e5811.
[20] Saitta C,Raffa G,Alibrandi A,et al. PIVKA-Ⅱis a useful tool for diagnostic characterization of ultrasound-detected liver nodules in cirrhotic patients[J]. Medicine(Baltimore),2017,96(26):e7266.
[21] Kudo M,Izumi N,Kokudo N,et al. Management of hepatocellular carcinoma in Japan:Consensus-Based Clinical Practice Guidelines proposed by the Japan Society of Hepatology(JSH)2010 updated version[J]. Dig Dis,2011,29(3):339-364.