井沆,武红权,冉龙艳,郭青青,王树辉,杨珊
JING Hang,WU Hongquan,RAN Longyan,GUO Qingqing,WANG Shuhui,YANG Shan

• 1:贵州省人民医院检验科
• 2:浙江中医药大学医学技术学院

摘要(Abstract)：

目的:探讨血清异常凝血酶原(PIVKA-Ⅱ)联合甲胎蛋白(AFP)检测在原发性肝癌(PHC)早期诊断中的价值。方法:116例肝病患者按病种分为PHC组(n=34)、继发性肝癌组(n=17)、肝硬化组(n=41)及肝炎组(n=24),20名无肝病病史健康体检人员作为对照组,分别于入院、或体检时采用化学发光法检测各组受检者血清PIVKA-Ⅱ及AFP水平,分析PIVKA-Ⅱ及AFP单项或联合检测诊断PHC受试者工作曲线下面积(ROCAUC)、敏感度及特异性。结果:继发性肝癌组、肝硬化组、对照组和肝炎组血清AFP和PIVKA-Ⅱ水平低于PHC组(P <0. 001); ROC-AUC结果显示,AFP联合PIVKA-Ⅱ检测诊断PHC的AUCROC高于血清PIVKA-Ⅱ单项及AFP单项诊断PHC的AUCROC,PIVKA-Ⅱ又高于AFP(P <0. 05),PIVKA-Ⅱ单项检测对PHC的诊断价值优于AFP (Z=2. 581,P <0. 05),AFP联合PIVKA-Ⅱ检测对PHC的诊断价值优于AFP或PIVKA-Ⅱ单项检测(Z=3. 280、3. 450,P <0. 01);血清PIVKA-Ⅱ单项检测诊断PHC的敏感性及特异度高于AFP单项检测(P <0. 05),两项指标联合检测诊断PHC的敏感度和特异性高于PIVKA-Ⅱ或AFP单项检测(P <0. 05)。结论:PIVKA-Ⅱ是诊断原发性肝癌的敏感指标,血清PIVKA-Ⅱ联合AFP检测对PHC的诊断具有较高的特异性和敏感性。
Objective: To investigate the clinical values of abnormal serum prothrombin( PIVKA-Ⅱ) and alpha fetoprotein( AFP) in the diagnosis and therapeutic monitoring of primary hepatocellular carcinoma( PHC). Methods: 116 patients with liver disease as the exposed group,were divided into PHC group( 34 cases),secondary hepatocellular carcinoma group( 17 cases),liver cirrhosis group( 41 cases) and hepatitis group( 24 cases),while 20 normal people were served as the control group.Serum PIVKA-Ⅱ and AFP levels of each case,and area under the receiver operating characteristic( ROC-AUC),sensitivity and specificity of both PIVKA-II and AFP levels as well as the two indexes in the detection and diagnosis of HHC were analyzed. The difference and the changes of the indexes in each group were compared. Results: First,the serum PVIKA and AFP levels of patients with primary liver cancer were higher than those of patients with secondary liver cancer,liver cirrhosis,hepatitis and healthy controls( P < 0. 01). Second,the sensitivity of PIVKA-Ⅱ was higher than AFP in diagnosis of PHC,and the specificity and sensitivity of AFP + PIVKA-Ⅱ combined detection were higher than that of single test. Conclusion: PIVKA-Ⅱ is a sensitive index for the diagnosis of primary liver cancer. The combined detection of serum AFP and PIVKA-Ⅱ can improve the specificity and sensitivity of the diagnosis of PHC,and reduce the rate of misdiagnosis. It is helpful for early diagnosis and prognosis.

关键词(KeyWords)： 肝肿瘤,原发性;肝炎;肝硬化;凝血酶原;甲胎蛋白;早期诊断
hepatic carcinoma,primary;hepatitis;liver cirrhosis;prothrombin;alpha fetoprotein;early diagnosis

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技厅-贵州省人民医院科技联合基金项目[黔科合LS字(2012)002号]

作者(Author): 井沆,武红权,冉龙艳,郭青青,王树辉,杨珊
JING Hang,WU Hongquan,RAN Longyan,GUO Qingqing,WANG Shuhui,YANG Shan

DOI: 10.19367/j.cnki.1000-2707.2018.09.007

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