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Value of combined determination of hepatitis C virus genotype,AFP-L3,and P53 antibody in the diagnosis of hepatitis C virus-related hepatocellular carcinoma
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摘要: 目的探讨HCV基因分型、甲胎蛋白异质体（AFP-L3）和P53抗体联合检测在HCV相关肝细胞癌（HCV-HCC）中的诊断价值。方法选取2016年1月-2019年12月在绵阳市第三人民医院确诊的HCV-HCC患者84例及良性肝病对照组（丙型肝炎患者、HCV肝硬化患者） 84例。分别采用PCR-反向点杂交技术、ELISA方法、电化学发光法检测HCV基因分型、P53抗体、AFP-L3。计量资料组间比较采用t检验和Kruskal-Wallis H检验;计数资料组间比较采用χ2检验。通过logistic回归分析和受试者工作特征曲线（ROC曲线）比较各指标对HCV-HCC的诊断价值。结果 HCV-HCC组HCV 1b基因型（%）、AFP-L3（%）、P53抗体明显高于良性肝病对照组（χ2=5.714、Z=-9.27、Z=-9.92,P值均<0.05）。logistic回归分析结果显示,HCV基因分型、AFP-L3（%）、P53抗体对HCV-HCC的影响均有统计学意义（P值均<0.05）。将上述单项指标重新拟合并建立模型:Logit（Y）=-3...Abstract: Objective To investigate the value of combined determination of hepatitis C virus( HCV) genotype,the alpha-fetoprotein variant AFP-L3,and P53 antibody in HCV-related hepatocellular carcinoma( HCV-HCC). Methods A total of 84 patients with HCV-HCC who were diagnosed in our hospital from January 2016 to December 2019 were enrolled as HCV-HCC group,and 84 patients with benign liver diseases( hepatitis C and HCV liver cirrhosis) were enrolled as control group. The PCR-reverse dot blot hybridization technique was used to determine HCV genotype,ELISA was used to measure P53 antibody,and electrochemical luminescence was used to measure AFP-L3. The t-test and the Kruskal-Wallis H test were used for comparison between two groups; the chi-square test was used for comparison of categorical data between two groups. The logistic regression analysis and the receiver operating characteristic( ROC) curve were used to compare the value of each index in the diagnosis of HCV-HCC. Results Compared with the control group,the HCV-HCC group had a significantly higher proportion of patients with HCV 1 b genotype or AFP-L3 and a significantly higher level of P53 antibody( χ2=5. 714,Z =-9. 27,Z =-9. 92,all P < 0. 05). The logistic regression analysis showed that HCV genotype,AFP-L3,and P53 antibody had significant effects on HCV-HCC( all P < 0. 05). The above indices were fitted to establish a model of Logit( Y) =-3. 881 +0. 031 X(AFP-L3( %))+ 0. 043 XP53+ 1. 218 X(HCV genotype),in which Y was the positive probability value of combined determination. In the screening of HCV-HCC,Y had a significantly larger area under the ROC curve than HCV genotype( 0. 945 vs 0. 758,Z = 6. 17,P < 0. 001),AFP-L3( 0. 945 vs 0. 863,Z = 3. 97,P < 0. 001),and P53 antibody( 0. 945 vs 0. 887,Z = 3. 07,P = 0. 002). Y had higher AUC( 0.945),sensitivity( 90. 90%),specificity( 94. 00%),positive predictive value( 93. 80%),negative predictive value( 91. 16%),and diagnostic accuracy( 92. 44%) than each index alone. Conclusion HCV 1 b genotype,AFP-L3,and P53 antibody level are associated with the risk of HCV-HCC,and the combined determination of the three indices has important clinical significance in the early diagnosis of HCV-HCC.
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Key words:
- hepacivirus /
- carcinoma,hepatocellular /
- genotype /
- alpha-fetoproteins /
- tumor suppressor protein p53 /
- early diagnosis
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