异常凝血酶原-Ⅱ与甲胎蛋白在原发性肝癌诊断中的应用价值分析
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摘要
目的探讨异常凝血酶原-Ⅱ(abnormal prothrombin-Ⅱ,PIVKA-Ⅱ)与甲胎蛋白(alpha-fetoprotein,AFP)在原发性肝癌(hepatocellular carcinoma,HCC)诊断中的价值。方法选取我院2017年10月-2018年10月收治的肝病患者,包括原发性肝癌患者82例,其中男50例,女32例,平均年龄(63.20±8.32)岁;肝硬化患者、慢性肝炎患者各50例,男58例,女42例,平均年龄(61.41±6.92)岁;同期健康体检者50例,男31例,女19例,平均年龄(60.74±3.70)岁。利用ARCHTECT技术分别定量检测各组中PIVKA-Ⅱ与AFP的数值,分析PIVKA-Ⅱ与AFP的ROC曲线下面积(AUC)。结果 ROC曲线下分析显示单项检测中PIVKA-Ⅱ、AFP的AUC分别为0.954(95%CI:0.929～0.980)、0.842(95%CI:0.783～0.900);血清PIVKA-Ⅱ的最佳临界值为25.23 mAU/ml,AFP的最佳临界值为28.75 ng/ml;血清PIVKA-Ⅱ检测HCC的敏感度、特异度分别为80.49%、93.00%,血清AFP检测HCC的敏感度、特异度分别为65.85%、89.00%,单项检测血清PIVKA-Ⅱ的敏感度明显高于AFP(P <0.05);当两项指标并联检测时敏感度可高达85.37%,串联时特异度可高达96.0%。经过Spearman秩相关分析,PIVKA-Ⅱ、AFP的表达水平与原发性肝癌的肿瘤数量(r=0.347、0.218,P均<0.05)、TNM临床分期(r=0.494、0.355,P均<0.01)呈正相关。结论血清PIVKA-Ⅱ在HCC中的临床诊断价值优于AFP,两指标联合检测可提高HCC检测的敏感度。
Objective To investigate the diagnostic value of prothrombin-Ⅱ(PIVKA-Ⅱ) and alpha-fetoprotein(AFP) in primary hepatocellular carcinoma(HCC). Methods Patients with liver disease treated in our hospital were selected from October 2017 to October 2018, including 82 cases of primary liver cancer patients(50 males and 32 females with average age of 63.2±8.323 years),50 patients with chronic hepatitis and 50 patients with cirrhosis(58 males and 42 females with average age of 61.41±6.92 years), 50 cases of healthy check-up during the same period(31 males and 19 females with average age of 60.74±3.697 years), the values of PIVKA-Ⅱ and AFP in each group were detected by ARCHTECT technique, and the area under ROC curve(AUC) of PIVKA-Ⅱand AFP were calculated. Results The ROC curve analysis showed that the AUC of PIVKA-Ⅱ and AFP to diagnose HCC were0.954(95% CI, 0.929-0.980) and 0.842(95% CI, 0.783-0.900), respectively; The cut-off value of serum PIVKA-Ⅱ was 25.23 mAU/ml and AFP was 28.75 ng/mL; The sensitivity and speci?city were 80.49% and 93.00%, respectively for serum PIVKA-Ⅱin detecting HCC; and 65.85% and 89.00%, respectively for serum AFP; The sensitivity of serum PIVKA-Ⅱ was signi?cantly higher than that of AFP(P < 0.05). When the two indexes were used in parallel, the sensitivity was 85.37% and the speci?city in series was 96.0%; Spearman rank correlation analysis showed that the expression levels of PIVKA-Ⅱ and AFP were positively related to the number of tumors(r=0.347, 0.218, P < 0.05, respectively) and TNM staging(r=0.494, 0.355, P < 0.01, respectively).Conclusion The clinical diagnostic value of serum PIVKA-Ⅱ in HCC is better than that of AFP.
Objective To investigate the diagnostic value of prothrombin-Ⅱ(PIVKA-Ⅱ) and alpha-fetoprotein(AFP) in primary hepatocellular carcinoma(HCC). Methods Patients with liver disease treated in our hospital were selected from October 2017 to October 2018, including 82 cases of primary liver cancer patients(50 males and 32 females with average age of 63.2±8.323 years),50 patients with chronic hepatitis and 50 patients with cirrhosis(58 males and 42 females with average age of 61.41±6.92 years), 50 cases of healthy check-up during the same period(31 males and 19 females with average age of 60.74±3.697 years), the values of PIVKA-Ⅱ and AFP in each group were detected by ARCHTECT technique, and the area under ROC curve(AUC) of PIVKA-Ⅱand AFP were calculated. Results The ROC curve analysis showed that the AUC of PIVKA-Ⅱ and AFP to diagnose HCC were0.954(95% CI, 0.929-0.980) and 0.842(95% CI, 0.783-0.900), respectively; The cut-off value of serum PIVKA-Ⅱ was 25.23 mAU/ml and AFP was 28.75 ng/mL; The sensitivity and speci?city were 80.49% and 93.00%, respectively for serum PIVKA-Ⅱin detecting HCC; and 65.85% and 89.00%, respectively for serum AFP; The sensitivity of serum PIVKA-Ⅱ was signi?cantly higher than that of AFP(P < 0.05). When the two indexes were used in parallel, the sensitivity was 85.37% and the speci?city in series was 96.0%; Spearman rank correlation analysis showed that the expression levels of PIVKA-Ⅱ and AFP were positively related to the number of tumors(r=0.347, 0.218, P < 0.05, respectively) and TNM staging(r=0.494, 0.355, P < 0.01, respectively).Conclusion The clinical diagnostic value of serum PIVKA-Ⅱ in HCC is better than that of AFP.
引文
1 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,2017,12:47.
2符忠祥,王伊,许永华.原发性肝癌早期的CT、MRI影像学诊断[J].泸州医学院学报,2016,39(5):418-420.
3胡友明,张娟安,刘军,等.AFP、AFU、GPC3及GP73联合检测对原发性肝癌的诊断意义[J].实用癌症杂志,2017,32(3):375-377+388.
4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.
5 Torbenson M,Schirmacher P.Liver cancer biopsy--back to the future?![J].Hepatology,2015,61(2):431-433.
6 Jang ES,Jeong SH,Kim JW,et al.Diagnostic Performance of Alpha-Fetoprotein,Protein Induced by Vitamin K Absence,Osteopontin,Dickkopf-1 and Its Combinations for Hepatocellular Carcinoma[J].PLo S One,2016,11(3):e0151069.
7吴朝,霍娜,李俊,等.维生素K缺乏或拮抗剂Ⅱ诱导蛋白与肝细胞癌关系研究进展[J].中华实用诊断与治疗杂志,2017,31(6):607-609.
8郭兰生,王小平,赵延红,等.甲胎蛋白产生机制的细胞病理学研究进展[J].陕西医学杂志,2013,42(4):501-502.
9 Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
10孔宪涛.肿瘤标志物应用进展与评价[J].实用肿瘤杂志,2002,17(5):289-292.
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):976-979.
12朱宇,王海,王宏洁,等.血清PIVKA-Ⅱ在肝癌诊断中的应用[J].临床和实验医学杂志,2014,13(7):513-516.
13 Daniele B,Bencivenga A,Megna AS,et al.Alpha-fetoprotein and ultrasonography screening for hepatocellular carcinoma[J].Gastroenterology,2004,127(5 Suppl 1):S108-S112.
14中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)摘要[J].中华肝脏病杂志,2012,20(6):419-426.
15 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):3928-3935.
16毛艳红.PIVKA-Ⅱ联合AFP对原发性肝癌的诊断价值[J].肝脏,2016,21(12):1056-1059.
17 Kim MJ,Bae KW,Seo PJ,et al.Optimal cut-off value of PIVKA-II for diagnosis of hepatocellular carcinoma--using ROC curve[J].Korean J Hepatol,2006,12(3):404-411.
18 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):1-7.
19吴佳丽,向哲邑,柏乐,等.血清异常凝血酶原在原发性肝癌中的辅助诊断价值[J].临床检验杂志,2018,36(3):186-189.
20 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.
2符忠祥,王伊,许永华.原发性肝癌早期的CT、MRI影像学诊断[J].泸州医学院学报,2016,39(5):418-420.
3胡友明,张娟安,刘军,等.AFP、AFU、GPC3及GP73联合检测对原发性肝癌的诊断意义[J].实用癌症杂志,2017,32(3):375-377+388.
4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.
5 Torbenson M,Schirmacher P.Liver cancer biopsy--back to the future?![J].Hepatology,2015,61(2):431-433.
6 Jang ES,Jeong SH,Kim JW,et al.Diagnostic Performance of Alpha-Fetoprotein,Protein Induced by Vitamin K Absence,Osteopontin,Dickkopf-1 and Its Combinations for Hepatocellular Carcinoma[J].PLo S One,2016,11(3):e0151069.
7吴朝,霍娜,李俊,等.维生素K缺乏或拮抗剂Ⅱ诱导蛋白与肝细胞癌关系研究进展[J].中华实用诊断与治疗杂志,2017,31(6):607-609.
8郭兰生,王小平,赵延红,等.甲胎蛋白产生机制的细胞病理学研究进展[J].陕西医学杂志,2013,42(4):501-502.
9 Torre LA,Bray F,Siegel RL,et al.Global cancer statistics,2012[J].CA Cancer J Clin,2015,65(2):87-108.
10孔宪涛.肿瘤标志物应用进展与评价[J].实用肿瘤杂志,2002,17(5):289-292.
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):976-979.
12朱宇,王海,王宏洁,等.血清PIVKA-Ⅱ在肝癌诊断中的应用[J].临床和实验医学杂志,2014,13(7):513-516.
13 Daniele B,Bencivenga A,Megna AS,et al.Alpha-fetoprotein and ultrasonography screening for hepatocellular carcinoma[J].Gastroenterology,2004,127(5 Suppl 1):S108-S112.
14中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)摘要[J].中华肝脏病杂志,2012,20(6):419-426.
15 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):3928-3935.
16毛艳红.PIVKA-Ⅱ联合AFP对原发性肝癌的诊断价值[J].肝脏,2016,21(12):1056-1059.
17 Kim MJ,Bae KW,Seo PJ,et al.Optimal cut-off value of PIVKA-II for diagnosis of hepatocellular carcinoma--using ROC curve[J].Korean J Hepatol,2006,12(3):404-411.
18 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):1-7.
19吴佳丽,向哲邑,柏乐,等.血清异常凝血酶原在原发性肝癌中的辅助诊断价值[J].临床检验杂志,2018,36(3):186-189.
20 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.