【摘要】 目的探讨异常凝血酶原(PIVKA-Ⅱ)对原发性肝癌(PLC)的诊断价值。方法收集2015年12月至2016年5月于本院住院的436例肝病患者,其中原发性肝癌患者108例,慢性乙型肝炎(CHB)患者108例,慢性丙型肝炎(CHC)患者111例,肝硬化患者109例。采用电化学发光法检测所有患者血清PIVKA-Ⅱ和甲胎蛋白(AFP)水平。比较PIVKA-Ⅱ、AFP单独及联合检测诊断原发性肝癌的敏感度、特异度和曲线下面积。结果原发性肝癌组、慢性乙型肝炎组、慢性丙型肝炎组和肝硬化组患者血清PIVKA-Ⅱ水平(m Au/ml)分别为1708.5(14,75000)、24(10,916)、26(4,83)和22(1.13,5474),原发性肝癌组患者PIVKA-Ⅱ的中位值显著高于慢性乙型肝炎组、慢性丙型肝炎组和肝硬化组,差异有统计学意义(Z值分别为-10.899、-10.414、-11.415,P均<0.001)。原发性肝癌组、慢性乙型肝炎组、慢性丙型肝炎组和肝硬化组患者血清AFP水平(ng/ml)分别为436.3(0.79,7121000)、3.49(0.61,1614)、4.12(1.08,73.26)和4.57(0.73,9422),原发性肝癌组患者AFP的中位值显著高于慢性乙型肝炎组、慢性丙型肝炎组和肝硬化组,差异有统计学意义(Z值分别为-8.937、-9.124、-9.001,P均<0.001)。PIVKA-Ⅱ、AFP及PIVKA-Ⅱ联合AFP的敏感度分别为90.40%、94.15%、92.51%,差异无统计学意义(χ~2=4.105,P=0.318);PIVKA-Ⅱ、AFP及PIVKA-Ⅱ联合AFP的特异度分别为82.41%、61.11%、81.48%,其中PIVKA-Ⅱ及PIVKA-Ⅱ联合AFP与AFP单独检测的特异度差异有统计学意义(χ~2=3.167,P=0.014),而PIVKA-Ⅱ与PIVKA-Ⅱ联合AFP检测的特异度间差异无统计学意义(χ~2=4.973,P=0.403)。结论血清PIVKA-Ⅱ诊断原发性肝癌的价值高于AFP,PIVKA-Ⅱ与AFP联合PIVKA-Ⅱ的诊断价值无差异。更多还原

【Abstract】 Objective To investigate the diagnostic value of PIVKA-Ⅱ on primary liver cancer(PLC). Methods A total of 436 patients with liver diseases were enrolled in our hospital from December 2015 to May 2016, including 108 cases with PLC, 108 cases with chronic hepatitis B(CHB), 111 cases with chronic hepatitis C(CHC), and 109 cases with liver cirrhosis. The serum PIVKA-Ⅱ and alpha-fetoprotein(AFP) levels were measured by electrochemiluminescence in all patients. The sensitivity, specificity and AUS of PIVKA-Ⅱ, AFP and PIVKA-Ⅱcombined with AFP in diagnosing primary liver cancer were analyzed. Results The serum levels of PIVKA-Ⅱ(m Au/ml) in PLC group, CHB group, CHC group and liver cirrhosis group were 1708.5(14, 75000), 24(10, 916), 26(4, 83) and 22(1.13), respectively. The median value of PIVKA-Ⅱ in PLC group was significantly higher than those in CHB group, CHC group and liver cirrhosis group(Z =-10.899,-10.414,-11.415, P < 0.001). The serum levels of AFP(ng/ml) in PLC group, CHB group, CHC group and liver cirrhosis group were 436.3(0.79, 7121000), 3.49(0.61, 1614), 4.12(1.08, 73.26) and 4.57(0.73, 9422), respectively. The median value of AFP in PLC group was significantly higher than those in CHB group, CHC group and liver cirrhosis group(Z =-8.937,-9.124,-9.001, P < 0.001). The sensitivity of PIVKA-Ⅱ, AFP and AFP combined with PIVKA-Ⅱ in diagnosing PLC were 90.40%, 94.15% and 92.51%, respectively, which had no significant difference(χ~2 = 4.105,P = 0.318). The specificity of PIVKA-Ⅱ, AFP and AFP combined with PIVKA-Ⅱ in diagnosing PLC were 82.41%, 61.11% and 81.48%, respectively. The specificity of PIVKA-Ⅱ and PIVKA-Ⅱ combined with AFP in the diagnosis of PLC were significantly higher than that of AFP(χ~2 = 3.167, P = 0.014), which had no statistical difference between PIVKA-Ⅱ and PIVKA-Ⅱ combined with AFP(χ~2 = 4.973, P = 0.403). Conclusion The diagnosing value of serum PIVKA-Ⅱ in primary liver cancer is higher than that of AFP, but has no difference between PIVKA-Ⅱcombined with AFP.更多还原