血清GP73和AFP等十项肿瘤标志物联合诊断HBsAg阳性肝癌的研究

目的探讨血清高尔基体蛋白73（GP73）及甲胎蛋白（AFP）、癌胚抗原（CEA）、铁蛋白（SF）、糖基抗原（CA19-9、CA15-3、CA125）、碱性磷酸酶（ALP）、γ-谷氨酰基转肽酶（GGT）、亮氨酸氨基转肽酶（LAP）等肿瘤标志物单项和联合检测对乙型肝炎（乙肝）病毒表面抗原（HBsAg）阳性肝癌的诊断价值。方法收集85例慢性乙肝、74例乙肝肝硬化、133例HBsAg阳性肝癌患者及46例健康体检者的血清，对GP73及AFP、CEA、SF、CA19-9、CA15-3、CA125、ALP、GGT、LAP等肿瘤标志物进行检测，并对检测结果进行统计学分析。结果 Spearman相关分析表明血清GP73与AFP、CEA、SF、CA19-9、CA15-3、CA125、ALP、GGT、LAP均有一定的相关性（均P＜0.05），除CA125外，肝癌组的相关系数均比非肝癌组小；但只有GP73与AFP、GGT及LAP的相关性在两组间的差异有统计学意义（均P＜0.05）。GP73、AFP、CEA、SF、CA19-9、CA15-3、CA125、ALP、GGT、LAP在慢性乙肝组、乙肝肝硬化组、肝癌组和正常对照组中的差异均有统计学意义（均P＜0.05），肝癌组的GP73、AFP、LAP的血清水平均显著高于其他组（均P＜0.05）。ROC曲线分析表明，单项指标中以GP73的ROC曲线下面积最大（AUC=0.792）,但与AFP和ALP的差异不大（Z=0.127、1.908，P=0.899、0.056）。通过logistic回归对上述指标构建新的预测模型，联合预测因子（PRE）的AUC显著高于其它单项指标（均P＜0.05）。结论 GP73单项检测有较好的诊断作用，GP73联合AFP、CEA、SF、CA19-9、CA15-3、CA125、ALP、GGT、LAP检测可提高对HBsAg阳性肝癌的诊断效能。

Single detection of Golgi protein 73 and combined with other serum tumor markers in diagnosis of HBsAg-positive hepatocellular car- cinoma

Objective To evaluate single detection of Golgi protein 73（GP73） or combined with other serum tumor markers in diagnosis of HBSAg-positive hepatocellular carcinoma （HCC）. Methods Serum samples were col ected from 133 cases of HBsAg-positive HCC, 85 cases of chronic hepatitis B （CHB）, 74 cases of liver cirrhosis （LC） infected with HBV and 46 healthy subjects. Serum levels of GP73, AFP, CEA, SF, CA19- 9, CA15- 3, CA125, ALP, GGT and LAP were assayed and the results were analyzed. Results Spearman correlation analysis showed that levels of serum GP73 was associated with the levels of AFP, CEA, SF, CA19- 9, CA15- 3, CA125, ALP, GGT and LAP （P〈0.05）, not with CA125;the correlation coefficient of AFP, GGT and LAP in HCC group were lower than that in non- HCC group （P〈0.05）. There were significant differences in serum levels of GP73, AFP, CEA, SF, CA19- 9, CA15- 3, CA125, ALP, GGT and LAP between CHB, LC, HCC patients and normal controls （P〈0.05）. The serum levels of GP73, AFP and LAP in HCC group were significantly higher than those in other groups（P〈0.05）. ROC curve anal-ysis showed that there was no significant difference in area under ROC among GP73, AFP and ALP （Z=0.127 and 1.908 respec-tively, P=0.899 and 0.056 respectively）, although the AUC of GP73 was the largest （AUC=0.792）. By logistic regression, we used all these indicators to build a new prediction model. The results showed that the AUC of the combined markers was significantly higher than any single markers （P〈0.05）. Conclusion GP73 is a high sensitive and specific serum mark for diagnosis of PHC and the detection of GP73 combined with AFP, CEA, SF, CA19- 9, CA15- 3, CA125, ALP, GGT and LAP can improve the diag-nostic value for HBsAg- positive HCC patients.