| 柯建飞,项国谦.异常凝血酶原在肝细胞肝癌诊断中的临床价值[J].浙江中西医结合杂志,2022,32(11): |
| 异常凝血酶原在肝细胞肝癌诊断中的临床价值 |
| Diagnostic value of PIVKA-II in Hepatocellular Carcinoma |
| 投稿时间：2021-10-28 修订日期：2022-10-07 |
| DOI： |
| 中文关键词: 异常凝血酶原、甲胎蛋白、肝细胞肝癌、肝硬化 |
| 英文关键词:PIVKA-II,AFP,Primary Hepatocellular Carcinoma,Cirrhosis |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨异常凝血酶原（PIVKA-II）和血清甲胎蛋白（AFP）单项及联合检测在肝细胞肝癌（hepatocellular carcinoma, HCC）和肝硬化(liver cirrhosis, LC）诊断中的临床应用价值。方法 收集2020年11月-2021年3月在浙江大学医学院附属杭州市第一人民医院确诊的肝细胞肝癌患者45例、肝硬化患者36例以及同时期健康体检者40例，采用化学发光免疫分析法分别检测PIVKA-II和AFP的血清含量。采用单因素方差分析比较三组间的均数，两变量之间行相关分析。同时构建受试者工作特征 (receiver operating characteristic, ROC) 曲线以及分析曲线下的面积 (area under ROC curve, AUC) 来分别评价PIVKA-II单独及联合AFP检测对HCC的诊断效能。结果 HCC患者组血清PIVKA-II水平与健康体检组比较，差异有统计学意义(P<0.05)；HCC患者组血清PIVKA-II水平与肝硬化患者组比较，差异有统计学意义(P<0.05)；肝硬化患者组血清PIVKA-II水平和健康体检组相比，差异无统计学意义（P >0.05）；当血清PIVKA-II的临界值为47.715mAU/mL时，HCC患者组ROC的曲线下面积（AUC）为0.884，95%的置性区间（CI）为0.815～0.953；当血清AFP的临界值为4.35ug/L时，HCC患者组ROC的曲线下面积（AUC）为为0.787，95%的置性区间（CI）为0.690～0.883；PIVKA-II+AFP联合检测时，HCC患者组ROC的曲线下面积（AUC）为0.901，95%的置性区间（CI）为0.838～0.963。异常凝血酶原（PIVKA-II）和甲胎蛋白（AFP）联合检测的敏感度为75.6%，特异性为95.0%。结论 血清PIVKA-II可作为HCC诊断的特异性指标，也可用于HCC和肝硬化的鉴别诊断。血清PIVKA-II联合血清AFP检测能进一步提高HCC诊断效能，有利于提高HCC患者的早期诊断。HCC患者的早发现可为临床治疗提供最有利的治疗时间。 |
| 英文摘要: |
| Objective To investigate the diagnostic value of single and combined detection of PIVKA-II and serum alpha-fetoprotein ( AFP) in hepatocellular carcinoma (HCC) and liver cirrhosis.Methods A total of 45 patients with hepatocellular carcinoma and 36 patients with liver cirrhosis diagnosed in Hangzhou First People's Hospital, Affiliated to Zhejiang University School of Medicine from November 2020 to March 2021, as well as 40 healthy subjects during the same period were collected. The serum levels of PIVKA-II and AFP were determined by chemiluminescence immunoassay.One-way anOVA was used to compare the mean values between the three groups, and correlation analysis was performed between the two variables.At the same time, the receiver operating characteristic (ROC) curve is constructed and the area under ROC curve is analyzed. AUC) to evaluate the diagnostic efficacy of PIVKA-II alone and in combination with AFP for HCC. Results Serum PIVKA-II levels in HCC patients were significantly different from those in healthy subjects (P < 0.05) .The PIVKA-II level of HCC patients was significantly different from that of liver cirrhosis patients(P < 0.05).There was no significant differences between the patients with liver cirrhosis patients and healthy subjects(P > 0.05).When the PIVKA-II cut-off value was 47.715mAU/mL, the AUC for diagnosing HCC was 0.884, 95% CI 0.815-0.953;When the AFP cut-off value was 4.35ug/l, the AUC for diagnosing HCC was 0.787,
95% CI 0.690-0.883;The AUC of PIVKA-II + AFP for the diagnosis of HCC was 0.901, 95% CI 0.838-0.963, The sensitivity and specificity of the combined detection of PIVKA-II and AFP were 75.6% and 95.0%.Conclusion Serum PIVKA-II can be used as a specific indicator for the diagnosis of HCC, and can also be used for the differential diagnosis of HCC and liver cirrhosis.Serum PIVKA-II combined with serum AFP detection can further improve the diagnostic efficiency of HCC, which is conducive to improving the early diagnosis of HCC patients.Early detection of HCC patients can provide the most favorable treatment time for clinical treatment. |
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