CT扫描联合肿瘤标志物AFP-L3、GP73诊断原发性肝癌的价值探讨
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摘要
目的:探讨联合运用CT增强扫描与ELISA法检测血清肿瘤标志物甲胎蛋白异质体(alpha-fetoprotein isoforms,AFP-L3)、高尔基体蛋白73(golgiprotein 73,GP73)浓度诊断原发性肝癌(primary hepatic carcinoma,PHC)的临床价值。方法:选取214例原发性肝细胞癌患者(PHC组)和242例良性肝病患者(良性肝病组)纳入本研究,分析所有病例的CT增强扫描结果以诊断PHC,并采用ELISA法检测患者血清AFP-L3、GP73浓度。分别探讨单独运用CT扫描、肿瘤标志物浓度检测及联合运用两种技术诊断PHC的价值。结果:良性肝病组肝硬化和脂肪肝患者的AFP-L3、GP73浓度分别为(25. 97±14. 55) ng/ml和(23. 78±12. 61)ng/ml、(57. 83±28. 56) ng/ml和(64. 43±26. 35) ng/ml,差异无统计学意义(P> 0. 05); PHC组病灶直径≤3 cm和>3 cm患者的AFP-L3、GP73浓度分别为(84. 20±76. 54) ng/ml和(158. 67±150. 56) ng/ml、(113. 34±90. 46) ng/ml和(210. 26±180. 61) ng/ml,差异有统计学意义(P <0. 05)。CT、AFP-L3、GP73对良性肝病组肝硬化、脂肪肝患者诊断的特异性和PHC组病灶直径≤3 cm、>3 cm诊断的灵敏度分别为78. 50%、85. 93%、67. 42%、88. 00%; 84. 11%、87. 41%、80. 90%、84. 80%; 80. 37%、80. 74%、78. 65%、80. 80%;三者联合诊断的特异性和灵敏度为76. 63%、79. 26%和88. 76%、91. 20%。结论:联合运用CT扫描及肿瘤标志物检测两种技术明显提高了PHC的诊断准确率。
Objective: To explore the value of CT scanning,detecting the serum AFP-L3,GP73 level and parallel use the two kinds of technologies in the early diagnosis of primary hepatocellular carcinoma( PHC). Methods: Select214 patients with PHC and 242 patients with benign liver diseases for this study,analysis CT scan and enhanced scan images to diagnosis PHC,use ELISA method to test the serum AFP-L3 and GP73 levels. Discussed the value of separately using CT scan,concentration of tumor markers detection and combined useing the two kinds of technology to diagnosis PHC. Results: The concentrations of AFP-L3 and GP73 in benign liver disease groups of patients with cirrhosis and fatty liver patients were( 25. 97 ± 14. 55) ng/ml,( 23. 78 ± 12. 61) ng/ml and( 57. 83 ± 28. 56) ng/ml,( 64. 43 ± 26. 35) ng/ml,have no statistical significance( P > 0. 05). The concentrations of AFP-L3 and GP73 in PHC groups of lesions ' diameter ≤3 cm and lesions ' diamete > 3 cm were( 84. 20 ± 76. 54) ng/ml,( 158. 67 ±150. 56) ng/ml and( 113. 34 ± 90. 46) ng/ml,( 210. 26 ± 180. 61) ng/ml respectively,have statistical significance( P < 0. 05). The sensitivity and specificity of CT,AFP-L3 and GP73 to diagnosis liver cirrhosis,fatty liver disease,PHC group lesion diameter of less than 3 cm and > 3 cm were 78. 50%,85. 93%,67. 42%,88. 00%,84. 11%,87. 41%,80. 90%,84. 80%,80. 37%,80. 74%,78. 65% and 80. 80%. The sensitivity and specificity of the combined diagnosis were 88. 76%,91. 20% and 76. 63%,79. 26%. Conclusion: Combined use CT scaning and tumor markers detection technologies significantly improved the diagnosis accuracy of PHC.
Objective: To explore the value of CT scanning,detecting the serum AFP-L3,GP73 level and parallel use the two kinds of technologies in the early diagnosis of primary hepatocellular carcinoma( PHC). Methods: Select214 patients with PHC and 242 patients with benign liver diseases for this study,analysis CT scan and enhanced scan images to diagnosis PHC,use ELISA method to test the serum AFP-L3 and GP73 levels. Discussed the value of separately using CT scan,concentration of tumor markers detection and combined useing the two kinds of technology to diagnosis PHC. Results: The concentrations of AFP-L3 and GP73 in benign liver disease groups of patients with cirrhosis and fatty liver patients were( 25. 97 ± 14. 55) ng/ml,( 23. 78 ± 12. 61) ng/ml and( 57. 83 ± 28. 56) ng/ml,( 64. 43 ± 26. 35) ng/ml,have no statistical significance( P > 0. 05). The concentrations of AFP-L3 and GP73 in PHC groups of lesions ' diameter ≤3 cm and lesions ' diamete > 3 cm were( 84. 20 ± 76. 54) ng/ml,( 158. 67 ±150. 56) ng/ml and( 113. 34 ± 90. 46) ng/ml,( 210. 26 ± 180. 61) ng/ml respectively,have statistical significance( P < 0. 05). The sensitivity and specificity of CT,AFP-L3 and GP73 to diagnosis liver cirrhosis,fatty liver disease,PHC group lesion diameter of less than 3 cm and > 3 cm were 78. 50%,85. 93%,67. 42%,88. 00%,84. 11%,87. 41%,80. 90%,84. 80%,80. 37%,80. 74%,78. 65% and 80. 80%. The sensitivity and specificity of the combined diagnosis were 88. 76%,91. 20% and 76. 63%,79. 26%. Conclusion: Combined use CT scaning and tumor markers detection technologies significantly improved the diagnosis accuracy of PHC.
引文
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[7]Zhang L,Mi CR.Comparative analysis of ultrasound,computed tomography and alpha fetoprotein in diagnosis of primary liver cancer[J].World Chinese Journal of Digestology,2015,23(1):139-141.[张力,米成嵘.腹部超声、CT及血清甲胎蛋白诊断原发性肝癌的临床疗效比较[J].世界华人消化杂志,2015,23(1):139-141.]
[8]He ZT.Clinical analysis of liver enhanced CT scan in the diagnosis of liver cancer[J].Journal of Imaging Research and Medical Applications,2017,1(4):11-13.[何正桃.肝脏增强CT扫描在肝癌诊断中的临床分析[J].影像研究与医学应用,2017,1(4):11-13.]
[9]Ma XL.Levels of serum AFP-L3 and GP73 in the diagnosis of hepatocellular carcinoma in China by Meta-analysis[J].Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases,2017,27(6):365-368.[马小兰.血清甲胎蛋白异质体和高尔基体蛋白73检测对肝癌诊断的价值[J].中西医结合肝病杂志,2017,27(6):365-368.]
[10]Man DL,Wang QH.Different liver diseases serum GP73,AFP-L3,AFP and AFU level expression[J].Chinese Hepatology,2016,21(5):368-371.[满冬亮,王齐晖.不同肝脏疾病血清GP73、AFP-L3、AFP及AFU水平的表达[J].肝脏,2016,21(5):368-371.]
[11]Huang HS,Zhou YJ,He LX,et al.Application of trace column centrifugation method for the detection of serum AFP variants[J].Laboratory Medicine and Clinic,2014,11(3):307-309.[黄海深,周永均,何兰香,等.微量离心柱法检测肝癌患者血清甲胎蛋白异质体临床意义分析[J].检验医学与临床,2014,11(3):307-309.]
[12]Huang Caiyun,Li Shilong,Zhou Xiuyan,et al.Significance of combined test of serum AFP-L3%,GP73,GPC3 in diagnosing primary hepatic carcinoma with low level of AFP[J].Modern Oncology,2017,25(21):3465-3467.[黄彩云,李世龙,周秀艳,等.联合检测AFP-L3%、GP73、GPC3在AFP低值原发性肝癌诊断中的价值[J].现代肿瘤医学,2017,25(21):3465-3467.]
[13]Zhang W,Qian JX,Xiao YG,et al.Research progress in detection of alpha-fetoprotein variants(AFP-L3)[J].Journal of Molecular Diagnostics and Therapy,2009,1(3):213-216.[张雯,钱金雄,肖彦革,等.甲胎蛋白异质体(AFP-L3)检测技术的研究进展[J].分子诊断与治疗杂志,2009,1(3):213-216.]
[14]Kladney RD,Cui X,Bulla GA,et al.Expression of GP73,aresident Golgi membrane protein,in viral and nonviral liverdisease[J].Hepatology,2002,35(6):1431-1440.
[15]Wang R,Wang XD,Li FH,et al.Clinical significance of Golgi glycoprotein 73 detection for the diagnosis of liver cancer[J].International Journal of Laboratory Medicine,2012,33(13):1572-1575.[王然,王晓东,李凤焕,等.高尔基体蛋白GP73在肝癌诊断中的临床意义[J].国际检验医学杂志,2012,33(13):1572-1575.]
[2]Sun ZD,Cheng LM,Ping P,et al.The evaluation function of liver cancer staging system on the prognosis of patients with surgery[J].Journal of Preventive Medicine of Chinese People's Liberation Army,2016,34(3):35.[孙志德,程利民,平萍,等.肝癌分期系统对手术患者预后的评估作用[J].解放军预防医学杂志,2016,34(3):35.]
[3]Liu YW,Wu XM.Diagnostic and prognostic significance of AFP,CA199 and CEA levels in patients with hepatocellular carcinoma[J].Laboratory Medicine,2017,32(5):406-409.[刘永炜,吴向民.血清AFP、CA199和CEA水平在肝癌诊断和预后中的作用[J].检验医学,2017,32(5):406-409.]
[4]Wang BL,Zhou LX.Diagnostic value of MRI and CT applied alone or in combination in hepatocellular carcinoma[J].Chinese Hepatology,2016,21(1):21-23.[王宝玲,周连新.MRI、CT单独或联合应用在肝细胞癌中的诊断价值[J].肝脏,2016,21(1):21-23.]
[5]Yan WQ,Xie MS,Liu Y.The clinical value of GP73,AFP-L3combined GPC-3 detection with in the diagnosis of primary hepatic carcinoma[J].Chinese Journal of Laboratory Diagnosis,2015,19(10):1651-1654.[晏文强,谢明水,刘杨.GP73、AFP-L3与GPC-3联合检测在原发性肝癌诊断中的临床价值[J].中国实验诊断学,2015,19(10):1651-1654.]
[6]Wang SL,Hu JM,He GL,et al.Combined detection of serum tumor markers in the diagnosis of primary hepatocellular carcinoma[J].Labeled Immunoassays and Clinical Medicine,2017,24(1):4-7.[王述莲,呼建民,何光伦,等.血清肿瘤标志物联合血常规指标检测在原发性肝癌诊断中的应用研究[J].标记免疫分析与临床,2017,24(1):4-7.]
[7]Zhang L,Mi CR.Comparative analysis of ultrasound,computed tomography and alpha fetoprotein in diagnosis of primary liver cancer[J].World Chinese Journal of Digestology,2015,23(1):139-141.[张力,米成嵘.腹部超声、CT及血清甲胎蛋白诊断原发性肝癌的临床疗效比较[J].世界华人消化杂志,2015,23(1):139-141.]
[8]He ZT.Clinical analysis of liver enhanced CT scan in the diagnosis of liver cancer[J].Journal of Imaging Research and Medical Applications,2017,1(4):11-13.[何正桃.肝脏增强CT扫描在肝癌诊断中的临床分析[J].影像研究与医学应用,2017,1(4):11-13.]
[9]Ma XL.Levels of serum AFP-L3 and GP73 in the diagnosis of hepatocellular carcinoma in China by Meta-analysis[J].Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases,2017,27(6):365-368.[马小兰.血清甲胎蛋白异质体和高尔基体蛋白73检测对肝癌诊断的价值[J].中西医结合肝病杂志,2017,27(6):365-368.]
[10]Man DL,Wang QH.Different liver diseases serum GP73,AFP-L3,AFP and AFU level expression[J].Chinese Hepatology,2016,21(5):368-371.[满冬亮,王齐晖.不同肝脏疾病血清GP73、AFP-L3、AFP及AFU水平的表达[J].肝脏,2016,21(5):368-371.]
[11]Huang HS,Zhou YJ,He LX,et al.Application of trace column centrifugation method for the detection of serum AFP variants[J].Laboratory Medicine and Clinic,2014,11(3):307-309.[黄海深,周永均,何兰香,等.微量离心柱法检测肝癌患者血清甲胎蛋白异质体临床意义分析[J].检验医学与临床,2014,11(3):307-309.]
[12]Huang Caiyun,Li Shilong,Zhou Xiuyan,et al.Significance of combined test of serum AFP-L3%,GP73,GPC3 in diagnosing primary hepatic carcinoma with low level of AFP[J].Modern Oncology,2017,25(21):3465-3467.[黄彩云,李世龙,周秀艳,等.联合检测AFP-L3%、GP73、GPC3在AFP低值原发性肝癌诊断中的价值[J].现代肿瘤医学,2017,25(21):3465-3467.]
[13]Zhang W,Qian JX,Xiao YG,et al.Research progress in detection of alpha-fetoprotein variants(AFP-L3)[J].Journal of Molecular Diagnostics and Therapy,2009,1(3):213-216.[张雯,钱金雄,肖彦革,等.甲胎蛋白异质体(AFP-L3)检测技术的研究进展[J].分子诊断与治疗杂志,2009,1(3):213-216.]
[14]Kladney RD,Cui X,Bulla GA,et al.Expression of GP73,aresident Golgi membrane protein,in viral and nonviral liverdisease[J].Hepatology,2002,35(6):1431-1440.
[15]Wang R,Wang XD,Li FH,et al.Clinical significance of Golgi glycoprotein 73 detection for the diagnosis of liver cancer[J].International Journal of Laboratory Medicine,2012,33(13):1572-1575.[王然,王晓东,李凤焕,等.高尔基体蛋白GP73在肝癌诊断中的临床意义[J].国际检验医学杂志,2012,33(13):1572-1575.]