AFP联合GGT/AST对HBV相关肝细胞癌的诊断价值

蔡馨; 陈娟娟; 汤冬玲; 张平安

doi:10.3969/j.issn.1001-5256.2021.09.021

AFP联合GGT/AST对HBV相关肝细胞癌的诊断价值

DOI: 10.3969/j.issn.1001-5256.2021.09.021

武汉大学人民医院检验科，武汉 430060

基金项目:

国家自然科学基金 (81773444);

湖北省自然科学基金 (2019CFC846)

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：蔡馨负责课题设计，资料分析，撰写论文; 陈娟娟、汤冬玲参与收集数据、论文修改; 张平安负责拟定写作思路，指导撰写文章并最后定稿。

详细信息

通信作者:
张平安，zhangpingan927@163.com

中图分类号: R512.62;R735.7
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出版历程
- 收稿日期: 2021-01-09
- 录用日期: 2021-04-02
- 出版日期: 2021-09-20

Value of alpha-fetoprotein combined with gamma-glutamyl transpeptidase/aspartate aminotransferase ratio in diagnosis of HBV-associated hepatocellular carcinoma

Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan 430060, China

Research funding:

National Natural Science Foundation of China (81773444);

Hubei Provincial Natural Science Foundation of China (2019CFC846)

摘要

摘要: 目的探讨AFP联合GGT/AST在HBV相关肝细胞癌(HCC)中的临床诊断价值。方法选取2019年1月15日—6月15日于武汉大学人民医院诊治的慢性乙型肝炎患者(CHB组)、乙型肝炎肝硬化患者(LC组)、HBV相关HCC患者(HCC组)和健康体检者(HC组)共352例，其中HC组86例，CHB组68例，LC组69例，HCC组129例，回顾性分析所有研究对象血清学检测数据。正态分布计量资料多组间比较采用方差分析，进一步两两比较采用LSD-t检验。偏态分布计量资料多组间比较采用Kruskal-Wallis H检验，进一步两两比较采用Nemenyi法检验。通过二元logistic回归分析计算出预测变量，并绘制AFP、GGT/AST以及预测变量单独或联合检测的受试者工作特征曲线(ROC曲线)，计算曲线下面积(AUC)及敏感度、特异度，采用Z检验对AUC进行比较。结果 HCC组GGT/AST和AFP水平均显著高于其他组(P值均＜0.05)。ROC曲线分析结果显示，在HCC组与LC组、HCC组与HC组+CHB组+LC组、HCC组与CHB组+LC组中，AFP与GGT/AST联合诊断的AUC均明显高于AFP单独诊断的AUC(Z值分别为2.684、2.241、2.415，P值分别为0.007、0.025、0.016)。结论 AFP联合GGT/AST可提高HBV相关HCC的临床诊断性能，具有一定诊断价值。
- 乙型肝炎病毒 /
- 癌, 肝细胞 /
- 甲胎蛋白类 /
- γ-谷氨酰转移酶 /
- 天冬氨酸氨基转移酶类
Abstract: Objective To investigate the clinical value of alpha-fetoprotein (AFP) combined with gamma-glutamyl transpeptidase (GGT)/aspartate aminotransferase (AST) ratio in the diagnosis of hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC). Methods A total of 352 subjects who received treatment or underwent physical examination in Renmin Hospital of Wuhan University from January 15 to June 15, 2020, were enrolled, among whom there were 86 healthy controls (HC group), 68 patients with chronic hepatitis B (CHB group), 69 patients with liver cirrhosis (LC group), and 129 patients with HCC (HCC group), and a retrospective analysis was performed for the serological test results of all subjects. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups, and the Nemenyi method was used for further comparison between two groups. A binary logistic regression analysis was used to calculate predictor variables; a receiver operating characteristic (ROC) curve was plotted for AFP, GGT/AST, and the predictor variables used alone or in combination, and the area under the ROC curve (AUC), sensitivity, and specificity were calculated; the Z test was used for comparison of AUC. Results The HCC group had significantly higher GGT/AST ratio and AFP than the other groups (all P < 0.05). The ROC curve analysis showed that AFP combined with GGT/AST ratio had a significantly higher AUC than AFP alone in the HCC group vs the LC group, the HCC group vs the HC+CHB+LC groups, and the HCC group vs the CHB+LC groups (Z=2.684, 2.241, and 2.415, P=0.007, 0.025, and 0.016). Conclusion AFP combined with GGT/AST ratio can improve the clinical diagnostic performance of HBV-related HCC and thus has a certain diagnostic value.
- Hepatitis B Virus /
- Carcinoma, Hepatocellular /
- Alpha-Fetoproteins /
- Gamma-Glutamyltransferase /
- Aspartate Aminotransferases

HTML全文

图 1 AFP与GGT/AST单独或联合检测诊断HCC的ROC曲线

注：a，HCC组与CHB组; b，HCC组与LC组; c，HCC组与HC组+CHB组+LC组; d，HCC组与CHB组+LC组。

下载: 全尺寸图片幻灯片

表 1 各组AFP、GGT、AST及GGT/AST血清学水平比较

组别	例数	AFP(ng/ml)	GGT/AST	GGT(U/L)	AST(U/L)
HC组	86	3.35(2.20~4.70)	0.98(0.71~1.36)	20.00(15.00~27.00)	21.00(18.00~24.00)
CHB组	68	4.35(2.35~15.75)	0.82(0.46~1.25)	51.00(23.75~140.75)¹⁾	61.00(34.25~125.00)¹⁾
LC组	69	8.60(2.70~54.20)¹⁾	0.97(0.55~1.81)	69.00(27.00~113.00)¹⁾	47.00(31.00~88.00)¹⁾
HCC组	129	157.10(9.90~6126.40)¹⁾²⁾³⁾	2.00(1.19~3.11)¹⁾²⁾³⁾	98.00(45.00~207.00)¹⁾²⁾³⁾	46.00(29.00~88.00)¹⁾²⁾
H值		124.018	70.202	126.282	135.987
P值		＜0.001	＜0.001	＜0.001	＜0.001
注：与HC组比较，1)P＜0.05;与CHB组比较，2)P＜0.05;与LC组比较，3)P＜0.05。

下载: 导出CSV

表 2 AFP与GGT/AST单独或联合检测在辅助HCC诊断中的价值

分组	标志物	AUC	95%CI	敏感度(%)	特异度(%)	P值
HCC组vs CHB组	AFP	0.803	0.742~0.864	72.9	72.1	＜0.05
	GGT/AST	0.789	0.717~0.861	67.4	83.8	＜0.05
	联合	0.846	0.790~0.910	79.8	77.9	＜0.05
HCC组vs LC组	AFP	0.760	0.693~0.826	55.8	84.1	＜0.05
	GGT/AST	0.727	0.650~0.803	90.7	46.4	＜0.05
	联合	0.802	0.741~0.862	48.1	97.1	＜0.05
HCC组vs HC组+CHB组+LC组	AFP	0.835	0.791~0.879	86.0	68.2	＜0.05
	GGT/AST	0.768	0.718~0.817	67.4	74.9	＜0.05
	联合	0.843	0.802~0.885	73.6	78.5	＜0.05
HCC组vs CHB组+LC组	AFP	0.781	0.727~0.835	55.8	85.4	＜0.05
	GGT/AST	0.758	0.700~0.815	67.4	77.5	＜0.05
	联合	0.823	0.775~0.871	81.4	66.4	＜0.05

下载: 导出CSV

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