血清AFP-L3和YKL-40对原发性肝癌的诊断价值及对经导管肝动脉化疗栓塞术的预后评估

目的探讨血清甲胎蛋白异质体(AFP-L3)和人软骨糖蛋白39(YKL-40)对原发性肝癌的诊断价值及对经导管肝动脉化疗栓塞术(TACE)术后的预后评估价值。方法选取2016年4月至2019年4月间辽阳市中心医院收治的54例原发性肝癌患者为观察组,另选取同期54例健康体检者为对照组。检测两组受试者血清AFP-L3和YKL-40水平,采用受试者工作特征曲线(ROC)分析AFP-L3和YKL-40在原发性肝癌中的诊断价值及对TACE术后的预后评估。结果治疗前,观察组患者血清AFP-L3和YKL-40水平均高于对照组;治疗后1个月,观察组患者血清AFP-L3和YKL-40水平均低于治疗前,而高于对照组,差异均有统计学意义(均P<0.05)。血清AFP-L3诊断原发性肝癌的曲线下面积(AUC)为0.776,血清YKL-40诊断原发性肝癌的AUC为0.632,两者联合诊断的AUC为0.803,两者联合诊断的敏感度和特异性为74.1%和90.3%,高于单独诊断的敏感度和特异性。截至2019年11月30日,54例患者均获得随访,死亡36例。根据治疗后1个月复测血清AFP-L3水平,将患者分为AFP-L3<18.37%组和≥18.37%组,Kaplan-Meier生存曲线显示。血清AFP-L3<18.37%组患者的中位生存时间为36.13个月,高于≥18.37%组的22.80个月。两组患者总体生存率比较,差异有统计学意义(P<0.05)。根据治疗后1个月复测YKL-40水平,将患者分为YKL-40<329.58 pg/ml组和≥329.58pg/ml组。Kaplan-Meier生存曲线显示,血清YKL-40<329.58pg/ml组患者的中位生存时间为35.32个月,高于≥329.58pg/ml组的25.61个月。两组患者总体生存率Log-rank检验,差异有统计学意义(P<0.05)。结论原发性肝癌患者血清AFP-L3和YKL-40水平升高,对原发性肝癌具有一定诊断价值,两者联合诊断的敏感度和特异性更高。原发性肝癌患者TACE术后血清AFP-L3和YKL-40水平有所降低,对TACE术后的预后评估具有临床意义。

Diagnostic value of serum AFP-L3 and YKL-40 levels for primary liver cancer and for the prediction of prognosis after transcatheter arterial chemoembolization

Objective To investigate the diagnostic value of serum alpha fetoprotein-L3(AFPL3)and human cartilage glycoprotein 39(YKL-40)for primary liver cancer and for the prediction of prognosis of patients undergoing transcatheter arterial chemoembolization(TACE).Methods Fifty-four patients with primary liver cancer admitted to Liaoyang Central Hospital from April 2016 to April 2019 were selected as the observation group,and 54 healthy individuals were selected as at the same period as the control group.The levels of serum AFP-L3 and YKL-40 in the two groups were detected.The receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of AFP-L3 and YKL-40 for primary liv-er cancer,and for the prediction of prognosis after TACE.Results Before the treatment,serum AFP-L3 and YKL-40 levels were higher in the observation group than in the control group.At 1 month after treatment,the levels of serum AFP-L3 and YKL-40 decreased in the observation group and were higher than in the control group(all P<0.05).The area under curve(AUC)was 0.776 for serum AFP-L3 and 0.632 for serum YKL-40 and 0.803 for the combination detection of AFP-L3 and YKL-40 for the diagnosis of primary liver cancer.The sensitivity and specificity were 74.1%and 90.3%,respectively for the combination detection of AFP-L3 and YKL-40 which was higher than each of the single detection.Up to November 30,54 patients were followed up and 36 patients were died.When patients were divided into two groups:AFPL3<18.37%and AFP-L3≥18.37%based on the repeat test of AFP-L3 at 1 month,Kaplan-Meier survival curse showed the median survival period was 36.13 months in patients with serum AFP-L3<18.37%which was higher than 22.80 months of patients with serum AFP-L3≥18.37%after treatment and there were significant differences in overall survival rate based on the Log-rank test(all P<0.05).When patients were divided into two groups:serum YKL-40<329.58 pg/ml and YKL-40≥329.58 pg/ml based on the repeat test of YKL-40 level at 1 month,Kaplan-Meier survival curse showed the median survival period was 35.32 months which was higher and there were significant differences in overall survival rate based on the Log-rank test(all P<0.05).Conclusion The elevated levels of serum AFP-L3 and YKL-40 have certain diagnostic value for primary liver cancer,and the combination detection of the two factors shows high sensitivity and specificity.The levels of serum AFP-L3 and YKL-40 were decreased in patients with primary liver cancer after TACE.AFP-L3 and YKL-40 have certain value for the prediction of the prognosis after TACE.