增强磁共振成像联合血清甲胎蛋白和脱-γ-羧基凝血酶原诊断肝细胞癌临床价值探讨

目的 探讨钆塞酸二钠（Gd-EOB-DTPA）增强磁共振成像(MRI)联合血清甲胎蛋白（AFP）和脱-γ-羧基凝血酶原（PIVKA-Ⅱ）诊断肝细胞癌（HCC)的临床价值。方法 2015年12月~2017年9月收治的82例肝病患者,经组织病理学诊断HCC组56例,非HCC组26例。罗氏cobas e 601型全自动电化学发光免疫分析系统检测血清AFP,采用LUMIPULSE G1200全自动免疫分析仪酶化学发光法检测血清PIVKA-Ⅱ。全部患者接受MRI检查。采用受试者工作特征曲线（ROC）下面积（AUC）判断各检查诊断的灵敏度、特异度和正确率。结果 HCC患者血清AFP和PIVKA-Ⅱ水平分别为34.5（4.5,594.9） ng/ml和63.5（25.0,2082.0） Mau/ml,显著高于非HCC组【分别为3.4（2.2,11.6） ng/ml和23.0（18.8,28.0） Mau/ml,P<0.01】;血清AFP、PIVKA-Ⅱ和Gd-EOB-DTPA增强MRI检查单独诊断HCC的ROC曲线下面积分别为0.763、0.815和0.907;在单项诊断 HCC 时,血清 AFP和PIVKA-Ⅱ的最佳临床诊断截断点分别为14.4ng/ml和40.5 Mau/ml,其诊断 HCC 的灵敏度、特异度和准确率分别为64.3%、84.6%、67.4%和62.5%、100.0%、74.4%,Gd-EOB-DTPA增强MRI单独诊断HCC的灵敏度、特异度和准确率分别为92.9%、88.5%、91.5%,以Gd-EOB-DTPA增强MRI诊断的效能最高;采用联合试验Ⅰ诊断HCC,其灵敏度为98.2%,特异度为61.5%,准确率为86.6%,采用联合试验Ⅱ诊断HCC的灵敏度为50.0%,特异度为100.0%,准确率为50.0%。联合试验提高了诊断的特异度,但降低了灵敏度。结论 应用血清AFP和PIVKA-Ⅱ检测联合Gd-EOB-DTPA增强MRI检查可提高诊断HCC的效能,综合应用三者联合诊断可以提高诊断HCC的正确性。

Clinical diagnostic efficacy of enhanced magnetic resonance imaging combined with serum AFP and PIVKA-Ⅱ in the diagnosis of patients with hepatocellular carcinoma

Objective To explore the clinical diagnostic efficacy of enhanced magnetic resonance imaging combined with serum AFP and protein induced by vitamin K absence or antagonist-II（PIVKA-Ⅱ） in the diagnosis of patients with hepatocellular carcinoma （HCC）. Methods A retrospective study was conducted on 82 patients with chronic liver diseases admitted to the First Hospital affiliated to Suzhou University between December 2015 and September 2017. 56 patients with HCC and 26 patients with chronic liver diseases （including 13 cases of liver cirrhosis and 13 cases of liver cyst） were diagnosed pathologically. All patients received serum AFP and PIVKA Ⅱ detection,as well as Gd-EOB-DTPA enhanced magnetic resonance imaging scans. Gd-EOB-DTPA enhanced magnetic resonance imaging scans were read by 3 radiologists,and the image rendering “fast in and fast out” and “low signal” in liver specific stage was defined as the characteristics of HCC. Serum AFP level was detected by roche cobas^® e type 601 automatic electrochemical luminescence immunoassay system testing,and serum PIVKA Ⅱ level was detected by using LUMIPULSE G1200 automatic immune analyzer and enzyme chemiluminescence method. Chi-square test was applied to detect the diagnosis efficacy among different parameters,and multiple independent samples nonparametric rank test was applied to compare serum AFP and PIVKA-Ⅱ levels. The sensitivity（Se）,specificity （Sp） and accuracy （Ac） were evaluated by the area under the ROC （AUC）. Results Serum AFP and PIVKA-Ⅱ levels in patients with HCC were 34.5（4.5,594.9） ng/ml and 63.5（25.0,2082.0） Mau/ml,significantly higher than 【3.4（2.2,11.6） ng/ml and 23.0 （18.8,28.0） Mau/ml,P<0.01】 in patients with chronic liver diseases;the area under ROC curve of serum AFP,PIVKA-Ⅱ levels and MRI in diagnosing HCC were 0.763,0.815,and 0.907,respectively;the cut-off-value of serum AFP level was 14.4 ng/ml,with Se,Sp and Ac of HCC diagnosis were 64.3%,84.6% and 67.4%,respectively,that of serum PIVKA-Ⅱ level was 40.5 Mau/ml,with Se,Sp and Ac of HCC diagnosis were 62.5%,100.0% and 74.4%,and the Se,Sp and Ac of HCC diagnosis by enhanced magnetic resonance imaging were 92.9%,88.5% and 91.5%;taking any one parameter among the three positive as the diagnostic criteria,the Se,Sp and Ac of HCC diagnosis were 98.2%,61.5% and 86.6%,while taking all three parameters positive as the diagnostic criteria,the Se,Sp and Ac of HCC diagnosis were 50.0%,100.0% and 50.0%. Conclusion The combination of serum AFP and PIVKA-Ⅱ detection and MRI in diagnosis of patients with HCC is efficacious,and the early diagnosis might be hard at present,which should be investigated in the future.