AFP、AFP-L3及PIVKA-II单独及联合检测在早期原发性肝细胞癌中的诊断价值

目的 探讨血清甲胎蛋白(alpha fetoprotein, AFP)、甲胎蛋白异质体(alpha fetoprotein-L3, AFP-L3)以及异常凝血酶原又称维生素K缺乏拮抗剂Ⅱ诱导产生的蛋白(protein induced by vitamin K absence or antagonist-Ⅱ, PIVKA-Ⅱ)单独及联合检测在早期原发性肝细胞癌(hepatocellular carcinoma, HCC)中的诊断价值。方法 回顾性挑选2021年4月~2022年5月在徐州医科大学附属医院住院或门诊的55例HCC患者作为HCC组,54例肝脏良性病变(benign liver disease, BLD)患者为BLD组,另选取43例健康体检人员为对照组,分别检测3组研究对象的血清AFP、AFP-L3及PIVKA-Ⅱ表达水平,绘制受试者工作特征(receiver operator characteristic, ROC)曲线,分析AFP、AFP-L3及PIVKA-Ⅱ单独及联合检测对HCC的诊断效能。结果HCC组患者血清AFP、AFP-L3及PIVKA-Ⅱ水平明显高于BLD组及对照组,差异有统计学意义(P<0.05),血清AFP、AFP-L3和PIVKA-Ⅱ的表达水平与HCC患者的肿瘤个数、最大径、TNM分期及门静脉癌栓有关,ROC曲线分析显示,HCC患者单独检测AFP、AFP-L3及PIVKA-Ⅱ的曲线下面积分别为0.809、0.828、0.896,联合检测3项指标的曲线下面积最高,为0.937。结论血清AFP、AFP-L3及PIVKA-Ⅱ单独检测均对HCC诊断具有一定的价值,但三者联合检测可提高HCC的诊断效能。     

AFP、AFP-L3和PIVKA-Ⅱ在肝细胞癌临床评估中的应用价值

目的探讨甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和异常凝血酶原(PIVKA-Ⅱ)在肝细胞癌(HCC)诊断中的应用价值。方法纳入2018年8月至2019年2月在深圳市第三人民医院确诊的330例肝病患者,其中包括110例慢性乙肝患者、110例肝硬化患者和110例肝细胞癌患者,采集患者血清,应用化学发光微粒子免疫检测法测定AFP和PIVKA-Ⅱ水平;用亲和吸附离心柱法分离血清AFP-L3,再用化学发光微粒子免疫检测法测定AFP-L3水平。结果肝细胞癌组患者AFP、AFP-L3及PIVKA-Ⅱ表达水平显著高于慢性乙肝组(P0.000 1)和肝硬化组(P0.000 1)。单独诊断HCC时,ROC分析显示,AFP、AFP-L3和PIVKA-Ⅱ的AUC分别为0.913(0.871～0.946)、0.881(0.834～0.928)、0.850(0.796～0.905),AFP诊断性能最佳。当AFP临界值为11.81 ng/mL时,诊断肝癌的灵敏度为88.18%,特异性为80.91%;当AFP-L3比值临界值为1.215 ng/mL时,灵敏度为84.55%,特异性为89.09%;当PIVKA-Ⅱ临界值为51.81 mAU/mL时,灵敏度为73.64%,特异性为94.55%。联合检测诊断HCC时,联合指标检测同时阳性的特异性比单指标检测肝癌的特异性提高,联合检测任一阳性时的灵敏度比单指标检测肝癌的灵敏度提高。大部分组合间的AUC增加至0.95以上。结论 PIVKA-II、AFP-L3、AFP是诊断HCC的有效生物标志物。与单独分子检测诊断HCC相比,其组合大部分可以提高诊断性能。     

原发性肝癌术后甲胎蛋白异质体及异常凝血酶原的测值改变结果分析

目的:探讨原发性肝癌术后异常凝血酶原(PIVKA-Ⅱ)、甲胎蛋白(AFP)、甲胎蛋白异质体比率AFP-L3%(AFP-L3/AFP)的改变状况。方法:回顾性分析原发性肝癌患者50例,其中40例患者同意手术治疗,对40例术后患者分别采用Centaur XP全自动化学发光免疫分析仪、亲和吸附离心法和LUMIPULSE G1200全自动免疫分析仪分别检测AFP、AFP-L3%、PIVKA-Ⅱ水平。结果:原发性肝癌患者手术前PIVKA-Ⅱ、AFP、AFP-L3%的检测水平与40例手术治疗患者的PIVKA-Ⅱ、AFP、AFP-L3%的检测水平相比较,差异具有统计学意义(P<0.05)。手术后患者PIVKA-Ⅱ、AFP、AFP-L3%、AFP+PIVKA-Ⅱ+AFP-L3/AFP的敏感性和特异性诊断结果绘制ROC曲线并进行逐步回归分析。结论:PIVKA-Ⅱ、AFP、AFP-L3%联合检测可为原发性肝癌患者后期治疗、复发监测提供较可靠的临床依据。     

766例肝病患者血清Pivka-Ⅱ检测结果分析

目的评价血清异常凝血酶原(PIVKA-Ⅱ)检测在原发性肝癌中的诊断价值。方法收集在我院收治的住院病人及健康体检人群血清标本共968份,其中原发性肝癌组202例,慢性乙型肝炎组385例,肝硬化组62例,脂肪肝组117例,其它消化系统疾病组93例,健康对照组109例。化学发光法分别检测标本中AFP和PIVKA-Ⅱ水平。分别以健康对照组和慢性肝病组为对照,计算AFP和PIVKA-Ⅱ单独检测和联合检测对原发性肝癌的诊断性能(敏感度、特异度、Kappa值以及ROC曲线等)。结果原发性肝癌组血清AFP和PIVKA-Ⅱ水平均高于其他各组(P<0.05)。AFP和PIVKA-Ⅱ单独检测和联合检测诊断原发性肝癌的敏感度分别为64.36%、95.05%、97.52%;以健康组为对照,AFP和PIVKA-Ⅱ单独检测和联合检测对原发性肝癌的诊断特异度分别为97.25%、98.17%、96.33%,Kappa值分别0.910、0.917、0.937,ROC曲线下面积分别为0.908、0.987、0.992;以慢性肝病组为对照,AFP和PIVKA-Ⅱ单独检测和联合检测对原发性肝癌的诊断特异度分别为80.67%、92.38%、76.95%,Kappa值分别0.654、0.831、0.621,ROC曲线下面积分别为0.801、0.976、0.963。结论血清PIVKA-Ⅱ在原发性肝癌的中诊断价值优于AFP,其与AFP的联合检测可提高原发性肝癌的诊断敏感度。     

AFP、PIVKA-Ⅱ和D-D联合检测在肝细胞癌中的诊断价值

目的 探讨甲胎蛋白(alpha-fetoprotein,AFP)、异常凝血酶原(prothrombin induced by vitamin K absence/antagonist-Ⅱ,PIVKA-Ⅱ)和D-二聚体(D-dimer,D-D)联合检测对肝细胞癌(hepatocellular carcinoma,HCC)的诊断价值.方法 本研究为回顾性病例对照研究.比较本院2018-01/2021-01月83例HCC患者、91例肝硬化患者及同期检测的105例健康体检者的AFP、PIVKA-Ⅱ和D-D的检测水平.采用Spearman相关分析方法探讨AFP、PIVKA-Ⅱ和D-D的关系,通过ROC曲线评估3种标志物单项检测和联合检测对HCC患者的诊断效果.结果 Spearman相关分析显示,HCC患者中AFP、PIVKA-Ⅱ和D-D三者之不存在显著相关性(P＞0.05),是3个独立的指标.与健康对照组和肝硬化组相比,HCC组患者AFP、PIVKA-Ⅱ和D-D的水平显著升高(P＜0.01);受试者工作特征曲线(receiver operating characteristic curve,ROC)显示,AFP、PIVKA-Ⅱ和D-D的cutoff值分别为9.61 ng/ml、52.50 mAu/ml和255.50 ng/ml,其中PIVKA-Ⅱ在单项检测中的曲线下面积(area under the curve,AUC)最大,AFP、PIVKA-Ⅱ和D-D三者联合检测的AUC值为0.962(95％ CI:0.937～0.988)(P＜0.01),大于任意两项联合检测或单项检测,其敏感度、特异度、约登指数、阳性预测值和阴性预测值分别为85.5％、95.6％、81.1％、85.3％和97.5％.结论 AFP、PIVKA-Ⅱ和D-D三者联合检测对HCC患者具有重要的临床诊断价值.     

三种血清标志物联合检测在早期肝细胞肝癌中的诊断价值

目的 探讨血清高尔基体蛋白73(GP73)、α-L岩藻糖苷酶(AFU)和甲胎蛋白(AFP)联合检测对早期肝细胞癌(HCC)的诊断价值.方法 收集2016年3月至2017年3月该院肝病患者222例,根据疾病类型分为早期HCC组(74例)、晚期HCC组(27例)、肝硬化组(74例)、慢性乙型肝炎组(47例),另选取同期体检健康者49例作为健康对照组.分别测定各组血清AFP、AFU和GP73水平,绘制受试者工作特征(ROC)曲线,评价3项指标单独和联合检测对早期HCC的诊断价值.结果 早期HCC组GP73、AFU和AFP水平均明显高于肝硬化组、慢性乙型肝炎组和健康对照组(P＜0.05).在肝癌筛查时,AFP单独诊断的ROC曲线下面积(AUC)为0.910(95％CI:0.864～0.936),两项指标联合时GP73和AFP联合诊断的AUC最大[0.925(95％CI:0.889～0.950)],灵敏度最高(95.0％).在鉴别诊断早期HCC与肝硬化时,单独诊断以GP73的AUC最大[0.842(95％CI:0.746～0.879)],特异度最高(86.5％);两项指标联合时GP73和AFU联合诊断的AUC最大[0.901(95％CI:0.788～0.907)].结论 GP73与AFP联合检测可以提高HCC筛查的诊断效能,GP73和AFU联合诊断能够提高早期HCC诊断效能,对于早期HCC和肝硬化的鉴别诊断具有重要意义.     

PIVKA-Ⅱ联合AFP检测在原发性肝癌中的诊断价值

目的探讨异常凝血酶原(PIVKA-Ⅱ)在原发性肝癌患者血清中的表达水平及其联合甲胎蛋白(AFP)检测在原发性肝癌中的诊断价值。方法收集88例原发性肝癌患者血清,同时收集61例胆囊相关疾病(包括胆囊癌、胆囊结石等)患者、110例肝脏良性疾病(包括慢性乙型肝炎、肝硬化等)患者、49例其他器官疾病(包括肺、消化道、胰腺等)患者以及110例健康体检人群血清作为对照。用化学发光法检测所有血清PIVKA-Ⅱ水平,用电化学发光法检测AFP水平。比较肿瘤标志物在各组间的表达水平,ROC曲线分析两种肿瘤标志物单独及联合应用对原发性肝癌的诊断价值。结果原发性肝癌组血清PIVKA-Ⅱ和AFP水平均高于其他疾病组,差异均有统计学意义(P0.01)。ROC曲线分析表明,血清PIVKA-Ⅱ和AFP的诊断临界值分别设定为140.26 m Au/m L和184.60 ng/m L时,其在诊断原发性肝癌中的ROC曲线下面积(AUC)分别为0.943(95%CI:0.913~0.974)和0.876(95%CI:0.829~0.922)、敏感性分别为84.10%和58.00%、特异性分别为95.50%和97.60%。PIVKA-Ⅱ联合AFP诊断原发性肝癌的AUC最大,为0.960(95%CI:0.938~0.982),敏感性为89.80%,特异性为92.70%。结论 PIVKA-Ⅱ诊断原发性肝癌的价值明显优于AFP,PIVKA-Ⅱ联合AFP检测将有助于提高原发性肝癌诊断的价值。     

血清GGT、AFP和AFP-L3联合检测对原发性肝癌诊断的临床意义

目的 探讨r-谷氨酰转移酶(GGT)、血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)联合检测对原发性肝癌诊断的诊断价值.方法 正常健康对照组84例,原发性肝癌组92例,良性肝病组45例,均同时检测血清GGT、AFP、AFP-L3.结果 原发性肝癌组血清GGT、AFP、AFP-L3与良性肝病组、正常健康对照组比较,差异有统计学意义(P＜0.01).原发性肝癌组血清GGT、AFP、AFP-L3单独检测时的敏感性分别75.5％、71.0％和83.7％,联合检测GGT和AFP或AFP-L3可使检测敏感性提高到79.3％和88.7％,三者联合检测敏感性为93.1％.结论 联合检测GGT、AFP、AFP-L3 3项指标可以大大提高原发性肝癌的诊断率.     

AFP、PIVKA-Ⅱ、AFU联合检测在乙肝病毒相关肝癌早期诊断的价值

目的探讨血清甲胎蛋白(AFP)、血清异常凝血酶原(PIVKA-Ⅱ)、α-L-岩藻糖苷酶(AFU)的检测在乙肝病毒相关肝细胞肝癌(HCC)诊断中的临床应用价值。方法收集638例慢性乙肝患者,其中包含2016年3月-2017年12月间在本院就诊的124例乙肝相关肝癌患者和同时间段来源于广州达安临床检验中心的325例单纯慢性乙肝患者以及189例乙肝肝硬化患者标本。对所有患者AFP、PIVKA-Ⅱ、AFU水平进一步分析。用ROC曲线评估3种标志物单独检测和联合检测用于从慢性乙肝患者中筛选乙肝相关肝癌的效果。结果与肝硬化乙肝组和慢性乙肝组相比,乙肝肝癌组患者血清中AFP和PIVKA-Ⅱ的水平明显升高,差异有统计学意义(P0.05)。乙肝肝癌组的AFU水平明显高于慢性乙肝组,差异有统计学意义(P0.05)。3种标志物单独检测时PIVKA-Ⅱ的AUC最大,其次为AFP,AFU的AUC最小(P0.05)。当AFP、AFU、PIVKA-Ⅱ3者联合检测时AUC最大,且诊断肝癌的敏感性和特异性分别达到88.4%和93.3%,高于3种标志物单独或者两者联合检测的敏感性和特异性。3种标志物联合检测从肝硬化患者中筛查肝癌时的AUC更大。结论 PIVKA-Ⅱ、AFU、AFP联合检测能够提升乙肝相关肝癌的早期诊断效率,尤其当慢性乙肝患者发生肝硬化时,联合检测筛选出肝细胞癌的能力更加突出。     

血清学标志物甲胎蛋白、PIVKA-Ⅱ和磷脂酰肌醇蛋白聚糖3联合诊断肝癌的meta分析

目的:探讨血清生物标志物甲胎蛋白（AFP）、维生素K缺失或拮抗剂Ⅱ诱导的蛋白质（PIVKA-Ⅱ）和磷脂酰肌醇蛋白聚糖3(GPC-3)单独或联合用于肝细胞癌（以下简称肝癌）诊断的价值。方法:检索PubMed、Web of Science、Embase三个数据库,收集2002年以来发表的AFP、PIVKA-Ⅱ和GPC-3单独或联合用于诊断肝癌的文献。根据纳入和排除标准筛选文献并提取相关数据。利用诊断准确性研究的质量评价（QUADAS）检查表对纳入的文献进行质量评价,并采用Meta DiSc软件、Review Manager 5.4软件和Stata 15.1软件对AFP、PIVKA-Ⅱ和GPC-3单用和联合使用诊断肝癌的受试者工作特征曲线下面积（AUC）、敏感度、特异度等指标进行数据分析。结果:共纳入32篇文献。Meta分析结果显示,单个标志物用于诊断肝癌时,PIVKA-Ⅱ的AUC值最高,为0.88(95%CI:0.85～0.91),其次是GPC-3和AFP;多个标志物联合用于诊断肝癌的AUC均高于单个标志物,其中PIVKA-Ⅱ联合GPC-3诊断的AUC值最高,为0.90(95%CI:0.8...     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.