摘要
目的:探究异常凝血酶原(PIVKA-Ⅱ)联合甲胎蛋白异质体(AFP-L3)检测在直径小于3 cm的早期肝癌诊断中的临床意义及应用价值。方法:回顾性分析2018年1月-2021年3月深圳市第三人民医院治疗并经病理明确诊断的98例病灶直径小于3 cm的肝癌患者相关临床资料及同期非肝癌肝占位性病变患者共46例的相关临床资料,统计分析不同组别患者PIVKA-Ⅱ、AFP-L3表达及确诊前影像学检查情况,比较各诊断方法针对早期肝癌诊断的敏感性及特异性。结果:肝癌组患者PIVKA-Ⅱ及AFP-L3中位数值及均值分别为:68.5 mAU/mL、23.0 ng/mL及(94.1±119.0) mAU/mL、(28.5±27.1)ng/mL,阳性表达PIVKA-Ⅱ及AFP-L3的比率分别为:70.4%、73.5%;非肝癌组患者PIVKA-Ⅱ及AFP-L3中位数值及均值分别为:18.5 mAU/mL、0 ng/mL及(42.0±50.4) mAU/mL、(3.0±5.1) ng/mL,阳性表达PIVKA-Ⅱ及AFP-L3的比率分别为43.5%、39.1%,肝癌患者组其PIVKA-Ⅱ及AFP-L3表达水平均显著高于非肝癌患者组,两组患者间比较,差异有统计学意义(P<0.05)。针对早期肝癌单一指标的诊断,AFP-L3的敏感性及特异性均为最高,分别为73.5%及60.9%。在联合指标检测诊断中,PIVKA-Ⅱ/AFP-L3的敏感性最高,为92.3%,PIVKA-Ⅱ+AFP-L3的特异性最高,为80.4%。受试者工作特征曲线分析则表明联合PIVKA-Ⅱ和AFP-L3诊断早期肝癌,其曲线下面积可提高至0.848。结论:针对直径小于3cm的肝癌的诊断,PIVKA-Ⅱ联合AFP-L3可有效提高早期诊断的敏感性和特异性。
Objective:To investigate the clinical significance and application value of abnormal prothrombin(PIVKA-II)combined with methemoglobin heteroplasm(AFP-L3)detection in the diagnosis of early hepatocellular carcinoma less than 3 cm in diameter.Methods:Clinical data related to 98 patients with hepatocellular carcinoma with lesions less than 3 cm in diameter treated in hospitals and clearly diagnosed by pathology from January 2018 to March 2021 and 46 patients with non-hepatocellular carcinoma liver-occupying lesions during the same period were retrospectively analyzed.PIVKA-Ⅱ,AFP-L3 expression and imaging before diagnosis were statistically analyzed in different groups of patients.The sensitivity and specificity of each diagnostic method for the diagnosis of early hepatocellular carcinoma were compared.Results:The median and mean values of PIVKA-Ⅱ and AFPL3 were 68.5 mAU/mL,23.0 ng/mL and(94.1±119.0)mAU/mL,(28.5±27.1)ng/mL in the hepatocellular carcinoma group,and the rates of positive expression of PIVKA-Ⅱ and AFP-L3 were 70.4%and 73.5%.The median and mean values of PIVKA-Ⅱ and AFP-L3 were 18.5 mAU/mL,0 ng/mL and(42.0±50.4)mAU/mL,(3.0±5.1)ng/mL in the non-hepatocellular carcinoma group,and the rates of positive expression of PIVKA-Ⅱ and AFP-L3 were 43.5%and 39.1%.The expression levels of PIVKA-Ⅱ and AFPL3 were significantly higher in the hepatocellular carcinoma group than in the non-hepatocellular carcinoma group,and the difference between the two groups was statistically significant(P<0.05).For the diagnosis of early-stage hepatocellular carcinoma with a single index,AFP-L3 had the highest sensitivity and specificity of 73.5%and 60.9%,respectively.Among the combined index tests for diagnosis,PIVKA-Ⅱ/AFP-L3 had the highest sensitivity of 92.3%and PIVKA-Ⅱ+AFP-L3 had the highest specificity of 80.4%.The analysis of the subjects’working characteristic curve showed that combining PIVKA-II and AFP-L3 for the diagnosis of early-stage hepatocellular carcinoma improved the area under the curve to 0.848.Conclusion:For the diagnosis of hepatocellular carcinoma less than 3 cm in diameter,PIVKA-Ⅱ combined with AFP-L3 can effectively improve the sensitivity and specificity of early diagnosis.
作者
宋燕州
康志龙
张昆
陈琦军
赵新
李志伟
SONG Yan-zhou;KANG Zhi-long;ZHANG Kun(Department of Hepatobiliary Surgery,The Third People’s Hospital of Shenzhen(The Second Affiliated Hospital of Southern University of Science and Technology),Shenzhen,Guangdong,518000,China)
出处
《黑龙江医学》
2023年第10期1220-1223,共4页
Heilongjiang Medical Journal
关键词
原发性肝细胞癌
异常凝血酶原
甲胎蛋白异质体
诊断
Primary hepatocellular carcinoma
Abnormal prothrombin
Alpha-fetoprotein heteroplasm
Diagnosis
