血清异常凝血酶原Ⅱ对HBV相关肝细胞癌的诊断价值

张莹; 颜学兵

doi:10.3969/j.issn.1001-5256.2018.07.021

血清异常凝血酶原Ⅱ对HBV相关肝细胞癌的诊断价值

DOI: 10.3969/j.issn.1001-5256.2018.07.021

张莹,
颜学兵

徐州医科大学附属医院感染性疾病科

基金项目:

国家自然科学基金(81371867)；江苏省医学科技专项-新型临床诊疗技术攻关(BL2014033)；江苏省“科教兴卫”医学重点人才培养基金(RC2011117)；江苏省“六大人才高峰”项目(2011-WS-068)；

详细信息

中图分类号: R735.7
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出版历程
- 收稿日期: 2017-12-29
- 出版日期: 2018-07-20

Clinical value of serum PIVKA-Ⅱ in diagnosis of HBV-related hepatocellular carcinoma

Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University

Research funding:

摘要

摘要: 目的研究血清AFP、维生素K缺乏或拮抗剂Ⅱ诱导蛋白（PIVKA-Ⅱ）单独或联合使用对HBV相关肝细胞癌（HCC）的临床诊断价值。方法选取2016年2月-2017年6月于徐州医科大学附属医院感染科实验室进行血清学检测的HBV相关HCC患者200例（其中手术治疗的患者80例）、乙型肝炎肝硬化患者143例、重度慢性乙型肝炎患者65例、慢性乙型肝炎肝衰竭患者42例,比较4组患者的AFP、PIVKA-Ⅱ水平。符合正态分布的计量资料多组间比较采用方差分析;不符合正态分布的计量资料多组间比较采用Krsukal-Wallis H检验,进一步两两比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验。采用二元logistic进行逐步回归分析得出2项指标联合预测因子的新变量,利用受试者工作特征曲线计算AFP、PIVKA-Ⅱ单独或联合诊断HBV相关HCC的曲线下面积（AUC）,AUC的比较采用De Long检验。结果 HBV相关HCC患者的AFP、PIVKA-Ⅱ水平高于其他3组,差异均有统计学意义（Z值分别为-9.432、-6.369、-2.158、-13.202、-9...
- 癌,肝细胞 /
- 异常凝血酶原Ⅱ /
- 诊断
Abstract: Objective To evaluate the clinical value of serum protein induced by vitamin K absence or antagonist-Ⅱ ( PIVKA-Ⅱ) and alpha-fetoprotein ( AFP) , alone or in combination, in the diagnosis of hepatitis B virus ( HBV) -related hepatocellular carcinoma ( HCC) . Methods A total of 450 patients with HBV infection, who underwent serological tests in the Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, from February 2016 to June 2017, were enrolled in our hospital, including 200 patients with HBV-related HCC ( 80 surgically treated cases) , 143 patients with hepatitis B cirrhosis, 65 patients with severe chronic hepatitis B ( CHB) , and 42 CHB patients with liver failure. The serum levels of PIVKA-Ⅱ and AFP were compared between the four groups. An analysis of variance was used to compare normally distributed continuous data between multiple groups; the Kruskal-Wallis H test was used to compare non-normally distributed continuous data between multiple groups, and the Mann-Whitney U test was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between groups. A binary stepwise logistic regression was used to obtain a new variable as a combination of PIVKA-Ⅱ and AFP. The receiver operating characteristic ( ROC) curve was used to calculate the area under the ROC curve ( AUC) of AFP and PIVKA-Ⅱ, alone or in combination, in the diagnosis of HBV-related HCC, and the De Long test was used for comparison of AUC between these variables. Results The HBV-related HCC patients had significantly higher PIVKA-Ⅱ and AFP levels than other groups ( Z =-9. 432, -6. 369, -2. 158, -13. 202, -9. 609, and-7. 584, all P< 0. 05) . The PIVKA-Ⅱ levels of the patients with severe CHB and CHB patients with liver failure were significantly higher than that of the patients with hepatitis B cirrhosis ( Z =-2. 977 and-2. 308, both P < 0. 05) . The HBV-related HCC patients showed significant reductions in AFP and PIVKA-Ⅱ levels within 5-7 days after surgical treatment ( Z =-96. 892 and-76. 997, both P < 0. 05) . In the diagnosis of HBV-related HCC, PIVKA-Ⅱ had 84. 0% sensitivity and 86. 4% specificity, and AFP had 81. 5% sensitivity and 50. 4%specificity. The AUCs of AFP, PIVKA-Ⅱ, and a combination of AFP and PIVKA-Ⅱ in the diagnosis of HBV-related HCC were0. 757, 0. 905, and 0. 912, respectively; there were significant differences in AUC between PIVKA-Ⅱ and AFP ( Z = 6. 048, P < 0. 001) and between AFP and a combination of AFP and PIVKA-Ⅱ ( Z = 7. 814, P < 0. 001) . A combination of AFP and PIVKA-Ⅱ had the highest diagnostic efficiency for HBV-related HCC. Conclusion Serum PIVKA-II has a better diagnostic value for HBV-related HCC than AFP, and a combination of the two can increase the detection rate of HCC and reduce the rate of misdiagnosis.
- carcinoma, hepatocellular /
- PIVKA-Ⅱ /
- diagnosis

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