【摘要】 目的比较分析肿瘤标志物血清异常凝血酶原(PIVKA-Ⅱ)和甲胎蛋白(AFP)检测对肝细胞癌(HCC)的诊断价值。方法选取2017年5月至2018年4月期间到我院收治的34例肝细胞癌患者(HCC)作为肝癌组,选取同期我院收治的40例良性肝病患者作为肝脏良性疾病组,30例健康体检者作为健康对照组。用化学发光法检测血清AFP和PIVKA-Ⅱ水平。比较分析二者单项和联合检测诊断HCC的敏感性、特异性、ROC曲线下面积。结果肝癌组的PIVKA-Ⅱ和AFP水平均高于肝脏良性疾病组和健康对照组,差异有统计学意义(P均<0.001);ROC曲线分析显示,两项指标联合检测诊断HCC的曲线下面积(AUC)最大,为0.957,明显高于AFP(0.744),差异有统计学意义(Z=3.22,P=0.001);略高于PIVKA-Ⅱ(0.949),但无统计学意义(Z=0.27,P=0.788)。PIVKA-Ⅱ和AFP单项检测的灵敏度分别为88.2%和58.0%,特异度分别为85.7%和94.3%;二者联合检测采用并联方式诊断HCC的灵敏度是91.2%(vs PIVKA-Ⅱ,P=0.480;vs AFP,P=0.0026),采用串联方式诊断HCC的特异度为98.6%(vs PIVKA-Ⅱ,P=0.004)。结论 AFP和PIVKA-Ⅱ单项检测时,相比AFP,PIVKA-Ⅱ具有较好的敏感性和特异性;两者联合检测能提高对HCC的诊断效能,弥补单项检测的不足。更多还原

【Abstract】 Objective To study the comparison of the diagnostic value of serum protein induced by vitamin K absence antagonist-Ⅱ(PIVKA-Ⅱ)and alpha-fetoprotein(AFP) in hepatocellular carcinoma(HCC). Methods From May 2017 to April 2018,there were 34 patients from inpatients as HCC group,40 patients with benign liver lesions as benign liver disease group,30 healthy people as healthy control group in the Central Hospital of Yiyang City. The serum levels of PIVKA-Ⅱ and AFP levels were detected by LUMI-PULSE G1200 automatic immunity analyzer,and the difference of the receiver operating characteristic curves(ROC-AUC) and the sensitivity and specificity of single PIVKA-Ⅱ or AFP assay,and the combined detection for HCC was compared. Results The serum levels of PIVKA-Ⅱand AFP in HCC group were higher than those in benign liver disease group and healthy control group(P<0.001),the ROC-AUC showed that the area under the curve of the combination of PIVKA-Ⅱ and AFP was 0.957,higher than the AFP(0.744,Z=3.22,P=0.001). But there was not statistically significant(Z=0.27,P=0.788) compared with the PIVKA-Ⅱ(0.949). Serum PIVKA-Ⅱ and AFP had a sensitivity of 88.2% and 58.0% respectively,a specificity of85.7% and 94.3% respectively. Combined detection of PIVKA-Ⅱ and AFP had a sensitivity of 91.2%,which was significant higher than AFP(P=0.0026),and a specificity of 98.6%,which was slightly higher than PIVKA-Ⅱ(P=0.004). Conclusion Compared with AFP,serum PIVKA-Ⅱ have a higher sensitivity and specificity. The combined detection of serum PIVKA-Ⅱ and AFP could increase the diagnostic value of HCC and remedy the deficiency of single assay.更多还原