摘要
目的评估高敏甲胎蛋白异质体比率(AFP-L3%)对诊治肝细胞癌的临床应用价值。方法纳入2016年10月至2018年3月在青岛大学附属医院确诊的160例肝细胞癌患者、32例肝内胆管细胞癌(ICC)患者、52例乙型肝炎后肝硬化患者、53例慢性乙型肝炎患者和50名健康体格检查者,测定所有受试者的血清高敏AFP-L3%和甲胎蛋白水平。统计学方法采用Mann-WhitneyU检验、Spearman相关性分析、配对符号秩和检验和卡方检验。结果肝细胞癌组血清高敏AFP-L3%和甲胎蛋白水平分别为24.90%(4.68%,61.85%)和113.45μg/L(11.18μg/L,1803.48μg/L),分别高于ICC组的0.50%(0.50%,0.50%)和2.79μg/L(1.72μg/L,4.04μg/L),肝硬化组的0.50%(0.50%,5.25%)和18.35μg/L(3.95μg/L,31.93μg/L),慢性肝炎组的0.50%(0.50%,4.25%)和2.70μg/L(1.80μg/L,17.00μg/L),健康对照组的0.50%(0.50%,0.50%)和1.94μg/L(1.46μg/L,2.63μg/L),差异均有统计学意义(高敏AFP-L3%U=461.00、1485.50、1141.00、625.00,甲胎蛋白U=401.50、2207.00、1254.00、266.00;P均<0.01)。血清高敏AFP-L3%和甲胎蛋白诊断肝细胞癌的灵敏度分别为66.3%和70.0%,差异无统计学意义(χ^2=0.54,P>0.05);两者联合检测的灵敏度为82.5%,分别高于单独检测的灵敏度,差异均有统计学意义(χ^2=24.04、18.05,P均<0.01)。血清高敏AFP-L3%的特异度为95.2%,高于甲胎蛋白的68.6%,差异有统计学意义(χ^2=26.04,P<0.01);两者联合检测的特异度为68.6%,低于单独检测高敏AFP-L3%的95.2%,差异有统计学意义(χ^2=26.04,P<0.01);两者联合检测与单独检测甲胎蛋白的特异度(68.6%)相比差异无统计学意义(P>0.05)。血清高敏AFP-L3%诊断甲胎蛋白阴性(甲胎蛋白<20μg/L)肝细胞癌患者的灵敏度为41.7%。血清高敏AFP-L3%和甲胎蛋白水平与肿瘤大小和临床分期均呈正相关(高敏AFP-L3%r=0.272、0.436,甲胎蛋白r=0.375、0.458;P均<0.01)。38例肝细胞癌患者术后血清高敏AFP-L3%降幅为82.2%,高于甲胎蛋白的69.2%,差异有统计学意义(U=532.50,P=0.049)。血清高敏AFP-L3%与甲胎蛋白水平之间无相关性(r=0.077,P>0.05)。结论血清高敏AFP-L3%诊断肝细胞癌的灵敏度与甲胎蛋白相当,但特异度高于甲胎蛋白;两者联合检测可提高肝细胞癌的诊断率。高敏AFP-L3%对甲胎蛋白阴性肝细胞癌具有较高的诊断价值。
Objective To evaluate the clinical application value of serum high sensitive α-fetoprotein variant ratio (hs-AFP-L3%) in the diagnosis and treatment of hepatocellular carcinoma. Methods From October 2016 to March 2018, at Affiliated Hospital of Qingdao University, 160 patients diagnosed with hepatocellular carcinoma, 32 patients with intrahepatic cholangiocarcinoma (ICC), 52 patients with post-hepatitis B liver cirrhosis, 53 patients with chronic hepatitis B and 50 healthy controls were enrolled. The serum levels of hs-AFP-L3% and α-fetoprotein were measured. Mann-Whitney U test, Spearman correlation analysis, Wilcoxon signed rank test and chi-square test were performed for statistical analysis. Results The serum levels of hs-AFP-L3% and α-fetoprotein in hepatocellular carcinoma group were 24.90%(4.68% to 61.85%) and 113.45 μg/L (11.18 μg/L to 1 803.48 μg/L), respectively, which were higher than those in ICC group (0.50%, 0.50% to 0.50%;and 2.79 μg/L, 1.72 μg/L to 4.04 μg/L), cirrhosis group (0.50%, 0.50% to 5.25%;and 18.35 μg/L, 3.95 μg/L to 31.93 μg/L), chronic hepatitis group (0.50%, 0.50% to 4.25%;and 2.70 μg/L, 1.80 μg/L to 17.00 μg/L), and healthy control group (0.50%, 0.50% to 0.50%;and 1.94 μg/L, 1.46 μg/L to 2.63 μg/L), and the differences were statistically significant (U=461.00, 1 485.50, 1 141.00, 625.00;401.50, 2 207.00, 1 254.00, 266.00;all P<0.01). The sensitivity of hs-AFP-L3% and α-fetoprotein in the diagnosis of hepatocellular carcinoma was 66.3% and 70.0%, respectively;and the difference was not statistically significant (χ^2=0.54, P>0.05). The sensitivity of the combined detection was 82.5%, which was higher than that of the separate detection, and the differences were statistically significant (χ^2=24.04 and 18.05, both P<0.01). The specificity of hs-AFP-L3% was 95.2%, which was higher than that of α-fetoprotein (68.6%), and the difference was statistically significant (χ^2=26.04, P<0.01). The specificity of the combined detection of these two markers was 68.6%, which was lower than that of hs-AFP-L3% alone (95.2%), and the difference was statistically significant (χ^2=26.04, P<0.01). There was no statistically significant difference in the specificity between the combined detection and α-fetoprotein detection alone (68.6%, P>0.05). The sensitivity of hs-AFP-L3% in the diagnosis of patients with α-fetoprotein-negative (α-fetoprotein<20 μg/L) hepatocellular carcinoma was 41.7%. The serum levels of hs-AFP-L3% and α-fetoprotein were both positively correlated with tumor size and clinical stage (hs-AFP-L3% r=0.272 and 0.436;α-fetoprotein r=0.375 and 0.458;all P<0.01). The reduction of serum hs-AFP-L3% in 38 patients with hepatocellular carcinoma after operation was 82.2%, which was higher than that of α-fetoprotein (69.2%), and the difference was statistically significant (U=532.50, P=0.049). There was no correlation between serum level of hs-AFP-L3% and α-fetoprotein level (r=0.077, P>0.05). Conclusions The sensitivity of hs-AFP-L3% is similar to that of α-fetoprotein in the diagnosis of hepatocellular carcinoma, while the specificity of hs-AFP-L3% is higher than that of α-fetoprotein. The combined detection of the two markers can improve the diagnostic rate of hepatocellular carcinoma. The hs-AFP-L3% has a high diagnostic value in α-fetoprotein-negative hepatocellular carcinoma.
作者
杨璇
孙桂荣
席强
彭冲
王麟
刘明军
田字彬
Yang Xuan;Sun Guirong;Xi Qiang;Peng Chong;Wang Lin;Liu Mingjun;Tian Zibin(Department of Clinical Laboratory,Affiliated Hospital of Qingdao University,Key Laboratory of Medicine and Health in Shandong Province,Qingdao 266003,China;Department of Gastroenterology,Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2019年第3期181-186,共6页
Chinese Journal of Digestion
关键词
甲胎蛋白类
癌
肝细胞
荧光抗体技术
异质体
Alpha-fetoprotein
Carcinoma, hepatocellular
Fluorescent antibody technique
Variant
