血清肿瘤标记物联合检测诊断原发性肝癌的临床应用研究

目的探讨血清肿瘤标记物甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)、糖类抗原199(CA199)、高尔基体膜蛋白73(GP73)联合检测诊断原发性肝癌的临床应用价值。方法采用电化学发光法和全自动生化分析仪分别检测125例原发性肝癌患者(恶性肿瘤组)治疗前及治疗后3个月血清AFP、AFU、CA199、GP73水平,与50例肝硬化患者(良性对照组)及50例健康体检者(健康对照组)对照,采用回顾性统计方法分析AFP、AFU、CA199、GP73联合检测在原发性肝癌早期诊断及监控治疗中的临床应用价值。结果 (1)原发性肝癌患者血清AFP、AFU、CA199、GP73水平显著高于良性对照组和健康对照组(P<0.01);(2)原发性肝癌患者血清肿瘤标记物水平与肿瘤分化程度、腹水、肝硬化、复发、转移明显相关(P<0.05);(3)原发性肝癌患者治疗3个月后血清肿瘤标记物水平较治疗前明显下降(P<0.01);(4)四项肿瘤标记物联合检测诊断原发性肝癌的敏感性、准确性、阴性预测值分别达到96.00%、93.71%、89.80%,与各单项检测比较差异有统计学意义(P<0.05)。结论血清肿瘤标记物AFP、AFU、CA199、GP73联合动态检测能够有效提高原发性肝癌的早期诊断率,减少误漏诊,并对判断肿瘤分化程度、复发转移及预后观察具有较高的临床应用价值。

Clinical application research of the diagnosis of primary liver cancer with the combined detection of serum tumor markers

Objective To study the clinical value of serum tumor markers, such as alpha fetoprotein（AFP）, Alpha L-fucus glycosidase（AFU）, carbohydrate antigen 199（CA199）, Golgi membrane protein 73（GP73）, in the diagnosis of primary liver cancer with combined detection method.Methods 125 patients with primary liver cancer were studied as a malignant tumor group, the level of serum tumor markers （AFP, AFU, CA199, GP73） was analyzed with electrochemical luminescence and fully automatic biochemical analyzer before treatment and after 3 months treatment respectively. Fifty patients with liver benign lesions and 50 healthy peoples were set as control groups. The serum tumor markers were statistical analysis retrospectively.Results （1）The level of serum tumor markers （AFP, AFU, CA199, GP73） in the patients with primary liver cancer were higher obviously than the other two groups（P〈0.01）. （2）The level of serum tumor markers in the patients with primary liver cancer had close correlations with tumor differentiation degree, ascitic fluid, cirrhosis of the liver, recurrence and metastasis（P〈0.05）. （3）The level of serum tumor markers after treatment were lower significantly than prior treatment（P〈0.01）. （4）By the combined detection of the four serum tumor markers in patients with primary liver cancer, the sensitivity, accuracy, negative predictive value reached 96.00%, 93.71%, 89.80%, respectively. It also had significant difference compared with single detection（P〈0.05）.Conclusion The combined detection of four serum tumor markers of AFP, AFU, CA199 and GP73 could effectively improve the positive rate of primary liver cancer, reduce missed diagnosis, and had high clinical value in judging tumor differentiation degree and prognosis, finding tumor recurrence and metastasis.