AFP和AFP-L3%联合检测在肝细胞癌诊断中的应用价值

关贵文; 姚明解; 钱相君; 翟相威; 闫晓彤; 赵景民; 鲁凤民; 陈香梅

doi:10.3969/j.issn.1001-5256.2019.07.019

AFP和AFP-L3%联合检测在肝细胞癌诊断中的应用价值

DOI: 10.3969/j.issn.1001-5256.2019.07.019

北京大学基础医学院病原生物学系
郑州大学公共卫生学院流行病学教研室
解放军总医院第五医学中心病理诊断与研究中心

基金项目:

国家十三五“艾滋病和病毒性肝炎等重大传染病防治”科技重大专项基金资助(2017ZX10302201)；北京市自然科学基金面上项目(7182079)；北京市科学技术委员会资助项目(Z161100000116047)；

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中图分类号: R735.7
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出版历程
- 收稿日期: 2019-03-01
- 出版日期: 2019-07-20

Value of combined measurement of alpha-fetoprotein and alpha-fetoprotein L3% in the diagnosis of hepatocellular carcinoma

Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center

Research funding:

摘要

摘要: 目的探究AFP联合AFP-L3%检测在肝细胞癌诊断中的应用价值。方法回顾性收集2010年1月-2017年12月在解放军总医院第五医学中心就诊的1208例慢性肝炎患者、1967例肝硬化患者和1569例肝细胞癌患者的血清学指标及临床资料。分析各组患者血清AFP及AFP-L3%的分布情况,比较AFP、AFP-L3%单独及两者联合诊断肝癌的灵敏度、特异度及受试者工作特征曲线下面积（AUC）,并分析AFP和AFP-L3、AFP-L3%的相关性。计量资料多组间比较采用单因素方差分析或KruskalWallis H检验,计数资料组间比较采用χ2检验。计量资料的相关性分析采用Spearman秩相关。AUC之间的比较采用Delong检验。采用logistic回归建立AFP-L3%及AFP联合诊断肝癌的模型。结果肝癌组AFP和AFP-L3水平均显著高于肝硬化组和慢性肝炎组（H值分别为1107. 3、1076. 9,P值均<0. 01）。肝癌组AFP-L3%阳性率为30. 9%,显著高于肝硬化（3. 0%）及慢性肝炎组（2. 8%）（χ2=768. 5,P ...
- 癌,肝细胞 /
- 甲胎蛋白类 /
- 诊断 /
- 曲线下面积
Abstract: Objective To investigate the value of combined measurement of alpha-fetoprotein ( AFP) and AFP-L3% in the diagnosis of hepatocellular carcinoma ( HCC) . Methods A retrospective analysis was performed for serological parameters and clinical data of 1208 patients with chronic hepatitis, 1967 patients with liver cirrhosis, and 1569 patients with primary HCC who attended The Fifth Medical Center of Chinese PLA General Hospital from January 2010 to December 2017. The distribution of serum AFP and AFP-L3% was analyzed, and AFP alone, AFP-L3% alone, and AFP combined with AFP-L3% were compared in terms of sensitivity, specificity, and area under the receiver operating characteristic curve ( AUC) . The correlation of AFP with AFP-L3 level and AFP-L3% was also analyzed. A one-way analysis of variance or the Kruskal-Wallis H test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Spearman rank correlation test was used for correlation analysis of continuous data, the Delong test was used for comparison of AUC, and logistic regression was used to establish the model of AFP combined with AFP-L3% for the diagnosis of HCC. Results The HCC group had significantly higher serum levels of AFP and AFP-L3 than the liver cirrhosis group and the chronic hepatitis group ( H = 1107. 3 and 1076. 9, both P < 0. 01) . The HCC group had a significantly higher positive rate of AFP-L3% than the liver cirrhosis group and the chronic hepatitis group ( 30. 9% vs 3. 0%/2. 8%, P < 0. 01) . The HCC group had a significantly higher level of AFP-L3 than the liver cirrhosis group and the chronic hepatitis group ( 3. 3 ( 0-13. 4) % vs 0/0, H = 1034. 1, P <0. 01) . The correlation analysis showed that serum AFP was significantly correlated with AFP-L3 level ( r = 0. 91, P < 0. 01) , and there was no correlation between AFP-L3% and AFP ( r = 0. 04, P > 0. 05) . With specificity remaining the same, AFP combined with AFP-L3% had a significantly higher sensitivity in the diagnosis of HCC than AFP alone ( 26. 6% vs 18. 4%, P < 0. 01) or AFP-L3% alone ( 36. 6% vs 30. 9%, P < 0. 01) . The subgroup analysis showed that for the samples with AFP ≥10 μg/L, AFP combined with AFP-L3%had a significantly higher AUC in the diagnosis of HCC than AFP alone ( 0. 745 vs 0. 701, P < 0. 01) ; for the tumor with a diameter of >2 cm or hepatitis B-related liver cancer, AFP combined with AFP-L3% had a significantly higher sensitivity than AFP alone ( 27. 6% vs18. 0%/27. 7% vs 19. 1%, both P < 0. 01) or AFP-L3% alone ( 37. 0% vs 30. 3%/36. 9% vs 31. 8%, both P < 0. 01) . For the group with a tumor diameter of ≤2 cm and the group without hepatitis B-related liver cancer, there was no significant difference in sensitivity between AFP combined with AFP-L3% and AFP or AFP-L3% alone in the diagnosis of HCC ( all P > 0. 05) . Conclusion AFP combined with AFP-L3% can significantly improve the sensitivity of HCC diagnosis and has a good clinical value in the diagnosis of hepatitis B-related liver cancer and liver cancer with a tumor diameter of > 2 cm.
- carcinoma, hepatocellular /
- alpha-fetoproteins /
- diagnosis /
- area under curve

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参考文献(18)

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