【摘要】 目的 探索乙肝表面抗原(HBs Ag)、抗丙型肝炎病毒(Anti-HCV)、HBV-DNA和甲胎蛋白(AFP)多指标联合检测在肝癌筛查中的可行性。方法 选择2014年5月至2015年10月中山市人民医院肝胆外科收治的原发性肝癌患者139例为病例组。在2012年中山市肝癌筛查队列人群中按年龄±5和性别以4∶1与病例组随机匹配,选择对照样本556人纳入对照组;采用酶联免疫吸附(ELISA)法检测研究对象血清标本中HBs Ag、Anti-HCV和AFP;运用PCR体外扩增荧光定量(FQ-PCR)法检测血清HBV-DNA;比较两组四项指标的阳性率,探讨单指标和多指标联合检测在肝癌筛查中的敏感度、特异度和漏检率。结果 单一指标筛查时,AFP敏感度最高,其次为HBs Ag。以HBs Ag为主体的联合筛查,不同指标联合筛查有不同的敏感度和漏检率,以HBs Ag、Anti-HCV、AFP联合HBV-DNA的敏感度最高,漏检率最低;其次为HBs Ag、AFP联合HBV-DNA;再次为HBs Ag、Anti-HCV联合AFP。结论 联合检测HBs Ag、Anti-HCV和AFP进行初筛,可以极大地提高肝癌高危人群的早期筛查效果。更多还原

【Abstract】 <Abstract>Objective To explore the feasibility of multi- index joint detection of hepatitis Bsurface antigen(HBs Ag), Anti-hepatitis C virus(Anti-HCV), HBV-DNA and alpha-fetoprotein(AFP) forscreening liver cancer. Methods From May 2014 to October 2015, one hundred and thirty-nine caseswith hepatocellular carcinoma in Zhongshan People’s Hospital were selected as case group. At the sametime, 556 cases were chosen as control group by age±5 and gender in the ratio of 4:1 randomly matchedgroup cases in Zhongshan Gity liver cancer screening research in 2012. HBs Ag, Anti-HCV and AFP inserum were detected by enzyme-linked immunosorbent assay(ELISA). FQ-PCR method was used to detectHBV-DNA in serum samples. Positive rate of single index indicators in the two groups, and the sensitivity,specificity, and false negative rate of multiple- index combined detection were explored inhepatocarcinoma screening. Results AFP sensitivity was the best for single index screening, followed byHBs Ag. When HBs Ag was used as the main body of the combined screening, the combination of differentindicators had different sensitivity, with the miss rate of HBs Ag, Anti-HCV, and AFP joined by HBV-DNA having the best sensitivity and the lowest miss rate; followed by HBs Ag, AFP joined by HBV-DNA;and by HBs Ag, Anti-HCV joined by AFP. Conclusion Combined detection of HBs Ag, Anti-HCV andAFP screening can improve the early screening effect of high-risk liver cancer patients.更多还原