AFP、AFP-L3、AFP-L3%和IL-6在乙肝肝硬化人群中诊断肝癌的价值

目的 探讨不同血清肿瘤标志物在乙肝肝硬化人群中预测和诊断肝癌的临床价值。方法 分析99例乙肝肝硬化患者、99例乙肝肝硬化合并原发性肝癌患者的临床资料，分别检测血清甲胎蛋白（AFP）、甲胎蛋白异质体（AFP-L3）和白介素6（IL-6）含量，并计算AFP-L3%（AFP-L3/AFP），比较两组间各血清肿瘤标志物表达水平差异，并计算各血清肿瘤标志物诊断肝癌的敏感度及特异性。结果 乙肝肝硬化组与乙肝肝硬化合并肝癌组之间AFP3.2（2.1，8.5） ng/ml vs 14.1（3.9，128.3） ng/ml]、AFP-L30.2（0.1，0.5） ng/ml vs 0.8（0.2，13.8） ng/ml]、AFP-L3%5.0%（5.0%，5.0%） vs 5.0%（5.0%，11.7%）]、IL-68.7（6.3，11.4） pg/ml vs 13.5（10.7，16.5） pg/ml]，差异均有统计学意义（P<0.05）。AFP在乙肝肝硬化人群诊断肝癌的敏感度为43.9%，特异性为84.8%；AFP-L3敏感度为48.1%，特异性为83.8%；AFP-L3%敏感度为29.3%，特异性为97.5%；IL-6敏感度为98.9%，特异性为34.3%。结论 血清肿瘤标志物AFP、AFP-L3、AFP-L3%均能有效用于乙肝肝硬化人群预测和诊断肝癌，AFP-L3%更具优势；IL-6敏感度虽高，但特异性低，不能有效用于肝癌的诊断。

Value of AFP, AFP-L3, AFP-L3% and IL-6 in Diagnosing Liver Cancer among People with Hepatitis B Cirrhosis

Objective To assess the value of different serum tumor markers in predicting and diagnosing liver cancer among patients with hepatitis B cirrhosis.Methods We analyzed medical records of 99 patients diagnosed with hepatitis B cirrhosis, and 99 patients diagnosed with hepatitis B cirrhosis complicated with primary hepatic carcinoma. Serum level of AFP, AFP-L3, IL-6 and AFP-L3% were measured. We calculated expression level difference of serum tumor markers between the two groups, as well as the sensitivity and specificity of these markers in diagnosing liver cancers.Results Serum level of each tumor marker expressed as median (interquartile range) for patients with and without primary hepatic carcinoma were as follows:AFP3.2(2.1,8.5)ng/ml vs 14.1(3.9,128.3)ng/ml], AFP-L30.2(0.1,0.5)ng/ml vs 0.8(0.2,13.8)ng/ml], AFP-L3%5.0%(5.0%,5.0%) vs 5.0%(5.0%,11.7%), IL-68.7(6.3,11.4)pg/ml vs 13.5(10.7,16.5)pg/ml]. All difference reached statistical significance (P<0.05). The sensitivity and specificity of each tumor markers in diagnosing primary hepatic carcinoma in patients with hepatitis B cirrhosis were 43.9% and 84.8% for AFP, 48.1% and 83.8% for AFP-L3, 29.3% and 97.5% for AFP-L3% and 98.9% and 34.3% for IL-6.Conclusion The serum tumor markers AFP, AFP-L3, and AFP-L3% can be effectively used to diagnose primary hepatic carcinoma among patient with hepatitis B cirrhosis, and AFP-L3% was most superior. Although IL-6 has high sensitivity, its low specificity precludes its value in diagnosing liver cancer in cirrhotic hepatitis B patients.