血浆Dickkopf同源物1检测对肝细胞癌的诊断价值

目的 探讨检测血浆Dickkopf同源物1(DKK1)对肝细胞癌(HCC)的诊断价值。方法 选取2014年11月～2015年12月南通市第三人民医院已确诊的HCC患者48例,肝硬化(LC)20例,慢性乙型肝炎(CHB)20例,选择排除其他慢性疾病的健康体检者(HC)20例,采用ELISA方法定量检测血浆中DKK1浓度,同时采用美国雅培i2000微粒子化学发光免疫分析仪检测其AFP。同时比较分析其ROC曲线及相关性。结果 HCC组DKK1水平均显著高于LC组、CHB组和HC组(Z=-4.132～-5.828,P均<0.001)。DKK1对HCC诊断价值的ROC曲线下面积为0.889,95%置信区间为0.831～0.947,DKK1诊断HCC最佳cutoff值为565 ng/L,其诊断灵敏度为93.8%,特异度为70%,AFP的ROC曲线下面积为0.759,95%置信区间为0.667～0.850。DKK1的AUC显著>AFP(Z=2.28,P=0.022)。DKK1和AFP两指标间无相关性(r=0.148,P=0.316),其中有21例AFP<20 μg/L而其DKK1>565 ng/L的诊断临界值。结论 检测血浆中DKK1可以作为AFP诊断HCC的有效补充,尤其是DKK1对AFP阴性HCC患者的早期诊断价值值得关注。

Diagnosis Value of Detecting Plasma Dickkopf-1 Patients with Hepatocellular Carcinoma

Objective To evaluate the diagnosis value of plasma Dickkopf-1(DKK1)in hepatocellular carcinoma(HCC)patients.Methods Selected 48 patients with HCC,20 patients with liver cirrhosis(LC), 20 patients with chronic hepatitis B(CHB),and all of them were clinically diagnosed in the Third People's Hospital of Nantong City,chose 20 cases ofhealth examination as healthy controls(HC),that were ruled out other chronic disease.Enzyme-linked immunosorbent assay(ELISA)and Abbott i2000 microparticle chemiluminescence immunoassay analyzer were used to determine the plasma DKK1and alpha-fetoprotein(AFP)levels.At the same time, analysesed and comparedthe receiver operating characteristic(ROC)curve and correlation of the DKK1 and AFP results.Results The plasma level of DKK1 in patients with HCC was significantly higher than that in patients with chronic hepatitis B,cirrhosis and healthy controls(Z=-4.132～-5.828,P<0.001).The areaunder ROC curve(AUC)of plasma DKK1 in the diagnosis of HCC was 0.889 and 95%confidence interval was 0.831～0.947,when the Cut-off value of DKK1 was 565ng/L,the sensitivity was 93.8% and specificity was 70% in diagnosing HCC.Theareaunder ROC curve of AFP in the diagnosis of HCC was 0.759 and 95% confidenceinterval was 0.667～0.850.The AUC of DKK1 was significantly higher than thatof AFP(Z=2.28,P=0.022).DKK1 and AFP in diagnosing HCC were no significantly correlated(r=0.148,P=0.316).21 patients with AFP under 20 μg/L showed higer DKK1 above 565 ng/L in 48 patients with HCC.ConclusionDetection of DKK1 in plasma can be used as a complement of AFP in thediagnosis of HCC,Especially DKK1 early diagnostic value of AFP negative HCC patients is remarkable.