【摘要】 目的探讨异常凝血酶原(DCP)、癌胚抗原(CEA)及血管内皮生长因子(VEGF)对原发性肝癌的诊断价值。方法采用酶联免疫吸附法检测本院收治的114例原发性肝癌、52例慢性乙型病毒性肝炎、42例肝硬化患者及40例健康体检者的血清DCP、CEA及VEGF水平。采用Logistic回归分析筛选具有诊断价值的指标。然后得出回归方程,最后采用ROC曲线评价回归方程的最佳诊断分界值及诊断效能。结果与非肝癌组患者相比,肝癌组患者血清DCP、CEA及VEGF水平明显高升高,差异有统计学意义(P<0.05)。肝癌组、肝炎组、肝硬化组及健康对照组血清DCP、CEA及VEGF水平比较,差异有统计学意义(P<0.05)。肝癌组患者血清DCP、CEA及VEGF水平明显高于肝炎组、肝硬化组及健康对照组,而健康对照组患者上述血清指标较肝癌组、肝炎组及肝硬化组明显降低,差异有统计学意义(P<0.05)。Logistic回归分析表明,血清DCP、CEA及VEGF水平升高与原发性肝癌发生密切相关。ROC分析结果提示DCP、CEA及VEGF的AUC分别为0.812、0.809、0.742,预测概率AUC为0.909,相较于单个指标显著提升,差异有统计学意义(P<0.05)。DCP、CEA、VEGF及联合预测概率的敏感度分别为83.2%、78.4%、70.2%及96.3%,特异度分别为79.3%、76.6%、75.8%及87.9%。DCP、CEA和VEGF最佳诊断界值分别为78.2 mAu/mL、7.9 ng/mL和182.32 ng/L。结论血清DCP、CEA及VEGF水平对原发性肝细胞癌具有一定的诊断价值,相较于单个指标,联合检测可明显提升诊断效能。更多还原

【Abstract】 Objective To explore the diagnostic value of abnormal prothrombin（DCP）,carcinoembryonic antigen（CEA）and vascular endothelial growth factor（VEGF）for primary liver cancer. Methods The enzyme-linked immunosorbent assay was used to detect the serum levels of DCP,CEA and VEGF in 114 patients with primary liver cancer,52 patients with chronic hepatitis B,42 patients with liver cirrhosis and 40 healthy subjects. Logistic regression analysis was used to screen indicators with diagnostic value. Then the regression equation is obtained,and the ROC curve was used to evaluate the best diagnostic cut-off value and diagnostic efficiency of the regression equation. Results Compared with patients in the non-liver cancer group,serum DCP,CEA and VEGF levels in the liver cancer group were significantly higher,and the difference was statistically significant（P<0.05）. The levels of serum DCP,CEA and VEGF in liver cancer group,hepatitis group,liver cirrhosis group and healthy control group were significantly different（P<0.05）.The serum levels of DCP,CEA and VEGF in liver cancer group were significantly higher than those in hepatitis group,liver cirrhosis group and healthy control group,while those in healthy control group were significantly lower than those in liver cancer group,hepatitis group and liver cirrhosis group（P<0.05）. Logistic regression analysis showed that the increase of serum DCP,CEA and VEGF levels is closely related to the occurrence of primary liver cancer. ROC analysis results showed that the AUC of DCP,CEA and VEGF were 0.812,0.809,0.742,respectively,and the predicted probability AUC was 0.909,which was significantly higher than that of a single indicator,and the difference was statistically significant（P<0.05）. The sensitivities of DCP,CEA,VEGF and the combined prediction probability were 83.2%,78.4%,70.2% and 96.3%,and the specificities were 79.3%,76.6%,75.8% and 87.9%,respectively. The best diagnostic cut-off values for DCP,CEA and VEGF were 78.2 mAu/mL,7.9 ng/mL and 182.32 ng/L,respectively. Conclusion Serum levels of DCP,CEA and VEGF have certain diagnostic value for primary hepatocellular carcinoma. The combined detection of the three can significantly improve the diagnostic efficiency.更多还原