α-L-岩藻糖苷酶对原发性肝癌诊断价值的探讨

探讨α－L－岩藻糖苷酶（alpha-L-fucosidase AFU)对原发性肝癌的诊断价值。分别采用放免法和显色多肽基质法对93例原发性肝癌、45例恶性肿瘤，98例良性肝病、46名孕产妇及20例正常健康人的血清中甲胎蛋白（alpha-fetoprotein AFP)水平和AFU活性进行联合检测。原发性肝癌组血清AFP水平及AFU活性明显高于其它各疾病组。AFU和AFP对原发性肝癌诊断的敏感性分别为76．3％和74．2％，在AFP阴性肝癌患者中AFU阳性率为75．0％。AFU，AFP两者联合检测诊断原发性肝癌的敏感性可提高到93．5％。     

血清铁蛋白及脂质唾液酸检测对原发性肝癌的诊断价值

为探讨血清恢蛋白(SF)、脂质唾液酸(LSA)对原发性肝癌的诊断价值,本文同时检测了86例原发性肝癌及其他良性疾病患者的血清SF及LSA,并与甲胎蛋白(AFP)进行对比。结果显示,原发性肝癌组血清SF及LSA水平明显高于非肝癌良性组,SF对原发性肝癌诊断的灵敏度为81.6％,特异度为83.3％,诊断正确率为82.5％,均较LSA为优,且对AFP阴性和轻度升高的原发性肝癌患者,有较高的检出率。本文提示,对疑患原发性肝癌者,除检测AFP外,可同时检测血清SF及LSA,特别是对AFP阴性患者,以期提高对原发性肝癌的诊断率。     

血清α—l—岩藻糖苷酶对原发性肝癌诊断价值的进一步探讨

本文用显色多肽基质法检测血清α-L-岩藻糖苷酶(AFU)共167例,结果进一步证明AFU 检测对原发性肝癌(PHC)(72例)诊断敏感性及特异性分别达75. 0％及90. 5％;在 AFP 阴性或低滴度阳性 PHC 病例中的阳性率达83. 3％;AFU 与AFP 联合检测使诊断 PHC 的阳性率上升为93. 1％。且随病情好转和恶化而下降和上升。血清AFU 值 EdmondsonⅡ级肝癌明显高于Ⅲ级。PHC 肿瘤组织 AFU 含量明显低于非肿瘤组织,提示 AFU 为分泌型肝癌标志物。     

AFP与AFU测定在原发性肝癌诊断中的临床意义

目的：探讨AFP（甲胎蛋白）、AFU（α-L-岩灌糖苷酶）的检测对原发性肝细胞癌的诊断价值。方法：AFP用酶联免疫法;AFU用比色法。结果：检测患者血清AFP与AFU。来诊断原发性肝细胞癌,其诊断符合率分别为68％和845,身份者联合检测其诊断符合率高达96％。结论：联合测定患者血清AFP与AFU诊断原发性肝细胞癌有较高的敏感性和特异性,尤其对AFP阴性和早期小肝癌有较大意义。其方法简单,适于基层临床开展。     

乙肝相关性肝癌患者血清五项指标联合诊断价值

目的研究乙肝相关性原发性肝癌患者癌胚抗原(CEA)、α-L-岩藻糖苷酶(AFU)、恶性肿瘤特异性生长因子(TSGF)、γ-谷氨酰转肽酶同工酶(GGT)与甲胎蛋白(AFP)水平联合诊断的价值。方法选取118例乙肝相关性肝癌患者设为肝癌组,另分别选取114例同期健康体检者、116例乙肝肝硬化患者作为正常组、肝硬化组,对比三组受试者AFP、TSGF、AFU、GGT、CEA水平,并对比各项指标单独诊断及联合诊断乙肝相关性原发性肝癌的结果。结果肝癌组AFP、TSGF、AFU、GGT、CEA含量均明显高于肝硬化组,且肝硬化组AFP、TSGF、AFU、GGT、CEA含量明显高于正常组(P0.05)。应用血清五项指标联合诊断乙肝相关性肝癌的灵敏度为88.1%,准确度为83.3%,特异度为80.9%,与AFP、TSGF、AFU、GGT、CEA等指标单项诊断结果比较明显增高(P0.05)。结论 AFP、TSGF、AFU、GGT及CEA指标联合应用于乙肝相关性肝癌患者早期诊断,诊断准确率较高,且检测方便。     

老年乙肝相关性原发性肝癌早期检测的标志物研究

目的探讨血清甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)及恶性肿瘤特异性生长因子(TSGF)检测对老年乙肝相关性原发性肝癌的临床诊断价值。方法选取2014年1月至2015年6月期间在我院肝病科住院治疗的老年乙肝相关性原发性肝癌患者45例(Ⅰ组),老年乙肝相关性肝硬化患者68例(Ⅱ组),另选取健康老年人80例作为正常对照组。对3组研究对象肝功能、AFP、AFU、TSGF进行检测并进行相关性研究。结果本研究结果显示,Ⅰ组丙氨酸氨基转移酶(ALT),天门氨酸氨基转移酶(AST)均高于Ⅱ组及对照组,白蛋白水平低于Ⅱ组及对照组,且差异具有统计学意义(P均0.05),Ⅱ组AST、ALT均高于对照组,白蛋白水平低于对照组,差异亦具有统计学意义(P均0.05);Ⅰ组血清AFP、AFU、TSGF均高于Ⅱ组及对照组,差异具有统计学意义(P均0.05)。临床分期越高、分化程度越低、肿瘤大小≥5 cm、肿瘤个数4,老年乙肝相关性原发性肝癌患者AFP水平越高(P0.05);临床分期越高、分化程度越低、肿瘤大小5 cm、肿瘤个数4,老年乙肝相关性原发性肝癌患者AFU水平越高(P0.05);临床分期越高,老年乙肝相关性原发性肝癌患者TSGF水平越高(P0.05)。结论联合检测血清AFP、AFU、TSGF水平对老年乙肝相关性原发性肝癌具有重要的诊断价值。     

AFU、PIVKA-II和AFP联合检测原发性肝癌的价值

目的分析AFU、PIVKA-II和AFP联合检测原发性肝癌的临床价值。方法选择2013年1月至2018年1月我院收治的原发性肝癌(PHC)患者69例为原发性肝癌组,良性肝病患者75例为良性肝病组,同期选择来我院进行体检的健康者80名为健康对照组。分别检测三组的AFU、PIVKA-II、AFP水平,并对比各血清标志物单一及联合诊断PHC的阳性率。结果 PHC组患者的AFU、PIVKA-II、AFP水平均高于良性肝病组和健康对照组,且良性肝病组患者的上述指标水平均高于健康对照组(P0.05);PHC组患者的AFU、PIVKA-II、AFP检测阳性率均高于良性肝病组和健康对照组,且良性肝病组患者的各阳性率均高于健康对照组(P0.05);PHC组AFU+PIVKA-II+AFP检查阳性率高于良性肝病组和健康对照组,且良性肝病组高于健康对照组(P0.05);AFU+PIVKA-II+AFP联合诊断PHC的敏感度、特异性均高于单一指标。结论 AFU、PIVKA-II和AFP联合检测PHC的检出率较高,临床诊断价值较高。     

肝癌患者血清AFP、AFU和SHCSP的联合检测

为探讨多种肝癌标志物联合检测对原发性肝癌的临床诊断价值。对79例经B超、计算机断层扫描(CT)诊断为肝癌的患者进行了甲胎蛋白(AFP)、α-L-岩藻糖苷酶(AFU)和特异性肝癌蛋白(SHCSP)的联合检测。单项AFP、AFU和SHCSP法在PHC组的阳性检出率分别为75．95％、72．15％及70．89％，AFP法与AFU法两项联检阳性率为91．14％，AFP法与SHCSP法两项联检，阳性率为89．87％，三项联检的阳性率97．47％，均显著高于任何单项检测的阳性率(χ^2＝15．87，P＜0．005)。AFU法和SHCSP法在19例AFP阴性的PHC病例中，阳性检出率分别为73．6％和68．42％。采用多种肿瘤标志物联合检测，可明显提高肝癌患者的诊断率，对肝癌的早期诊断，尤其对AFP阴性的肝癌诊断具有更重要的临床应用价值。     

联合检测血清α-L-岩藻糖苷酶、甲胎蛋白对原发性肝癌患者的临床意义

探讨血清α-L-岩藻糖苷酶(AFU)和甲胎蛋白(AFP)的联合检测对原发性肝癌(PHC)诊断的临床意义.应用自动生化分析仪测定正常人,非PHC的其它恶性肿瘤组,PHC组患者血清AFU的含量,应用时间分辨荧光免疫分析测定血清AFP含量.PHC、肝转移癌、胰腺癌均高于正常对照组(P＜0.01或P＜0.05),PHC阳性率高90.9%.AFU与AFP之间无相关性(P＞0.5).血清AFU在PHC中敏感性较高.联合检测AFU、AFP对明显提高PHC的诊断具有实用价值.     

血清高尔基蛋白73、甲胎蛋白异质体3、甲胎蛋白和α-L-岩藻糖苷酶水平诊断原发性肝癌的效能分析

目的探讨应用血清高尔基蛋白体73(GP73)、甲胎蛋白异质体3(AFP-L3)、AFP和α-L-岩藻糖苷酶(AFU)水平诊断原发性肝癌(PLC)患者的效能。方法 2015年1月～2017年3月我院诊治的PLC患者261例,乙型肝炎肝硬化患者201例,慢性乙型肝炎患者238例和体检健康人200例,采用酶联免疫吸附试验法检测血清GP73水平,采用亲和吸附离心管法检测血清AFP-L3,采用全自动化学发光仪检测血清AFP,采用商用试剂盒检测血清AFU水平。绘制血清GP73、AFP-L3、AFP和AFU诊断PLC的ROC曲线,确定截断点(cut-off-value),计算ROC曲线下面积(AUC),判断它们的诊断效能。结果肝癌组血清GP73水平显著低于慢性肝炎组和肝硬化组,差异有统计学意义(P0.05),血清AFP-L3显著高于其他3组,差异有统计学意义(P0.05),血清AFU水平显著高于健康人和肝硬化组,但低于慢性肝炎组,差异有统计学意义(P0.05);以非肝癌人群为对照,血清GP73、AFP-L3、AFP和AFU诊断肝癌的ROC曲线下面积分别为0.564 (95%CI:0.485～0.636)、0.724 (95%CI:0.555～0.786)、0.745(95%CI:0.654～0.806)和0.571(95%CI:0.385～0.536),血清AFP-L3联合AFP诊断肝癌的截断点分别为8.25%和49.25 ng/ml,其灵敏度(Se)为55.5%,特异度(Sp)为85.0%,正确性(Ac)为80.1%,显著高于血清AFP-L3诊断的55.5%、85.0%和76.4%或AFP诊断的57.1%、82.7%和75.2%(P0.05);在261例肝癌患者中,血清AFP9.6 ng/ml者71例(27.2%),其中PG73106.5 ng/ml者30例(42.3%),提示GP73对AFP阴性肝癌有一定的诊断价值;在201例肝硬化患者中,血清AFP9.6 ng/ml者98例(48.8%),其中PG73106.5 ng/ml者52例(53.1%),提示血清GP73水平容易受到肝硬化的影响。结论应用血清AFP联合AFP-L3检测能够提高诊断肝癌的效能,但它们的灵敏度都还不够高,影响因素较多。临床医生需结合病史、影像学检查和动态血清学检测才能做出更为科学的结论。     

A preliminary study on serum alpha-L-fucosidase assay in the diagnosis of hepatocellular carcinoma

Serum alpha-L-fucosidase (AFU) was determined in 33 patients with hepatocellular carcinoma (HCC), 4 with secondary metastatic liver cancer, 61 with various liver diseases, 12 with gastrointestinal tumor and 50 healthy controls. The results showed that AFU level was significantly higher in HCC (14.48 +/- 5.77) than that in the controls (3.33 +/- 0.72) and in patient with other diseases (P less than 0.01). Serum AFU level was also increased in fulminant hepatitis (8.96 +/- 3.99), acute hepatitis (8.94 +/- 4.94) and chronic hepatitis (7.27 +/- 2.58), P less than 0.01 or 0.05. There was no significant difference in AFU level between the controls and patients with secondary metastatic liver cancer (6.25 +/- 0.84), cirrhosis (6.30 +/- 3.17), gastrointestinal tumor (4.43 +/- 1.64), liver hemangioma and liver abscess (4.86 +/- 2.22). A level exceeding 10.5u was a useful marker for the diagnosis of HCC with 78.8% sensitivity and 90.0% specificity. The diagnostic positivity was 81.8% in low AFP producing HCC, whereas 93.9% in those with elevated AFP. Our data indicate that serum AFU is a useful tumor marker for HCC, particularly in detection of AFP-low or negative HCC patients.     

Alpha-L-fucosidase as a serum marker of hepatocellular carcinoma in Thailand

To evaluate the role of serum alpha-L-fucosidase (AFU) in the diagnosis of hepatocellular carcinoma (HCC), we simultaneously studied both AFU activity and alpha-fetoprotein (AFP) level in 60 patients with HCC, 60 patients with cirrhosis and chronic hepatitis each, 30 patients with other liver tumors and 60 healthy subjects. Serum AFU activity in patients with HCC (1,418.62 +/- 575.76 nmol/ml/hr) was significantly higher than that found in cirrhosis (831.25 +/- 261.13 nmol/ml/hr), chronic hepatitis (717.71 +/- 205.86 nmol/ ml/hr) or other tumors (706.68 +/- 197.67 nmol/ml/hr) and in controls (504.18 +/- 121.88 nmol/ml/hr, p < 0.05). With 870 nmol/ml/hr (mean value of controls plus 3 standard deviations) considered as the cut-off point, AFU was more sensitive (81.7 vs 39.1%) but less specific (70.7 vs 99.3%) than AFP at a level of > 400 ng/ml as a tumor marker of HCC. With both markers combined, the sensitivity was improved to as much as 82.6%. AFU activity in HCC patients was correlated to tumor size (r = 0.3529, p = 0.006) but not associated with tumor staging classified by Okuda's criteria (p = 0.1). The AFU activity in the viral hepatitis group (hepatitis B or C) was also significantly higher than in the non-viral group (p = 0.0005). We conclude AFU to be a useful marker, in conjunction with AFP and ultrasonography, for detecting HCC, particularly in patients with underlying viral hepatitis and cirrhosis.     

血清标志物在肝炎肝硬化患者中诊断肝癌的价值

目的寻找有效的适合用于肝炎肝硬化患者肝癌诊断的血清肿瘤标志物.方法AFP测定应用竞争性放射免疫技术(RIA),岩藻糖苷酶(AFU)测定应用酶化学技术,唾液酶(SA)测定应用化学法,可溶性白介素2受体(sIL-2R)和肝细胞生长因子(HGF)的测定应用单克隆抗体双夹心酶联免疫吸附试验(ELISA).结果AFU、AFP和SA三项指标肝癌患者显著高于肝硬化患者,P值分别为P=0.027,P＜0.001和P＜0.001.分别以AFU值440nmol/ml·h-1、AFP测定值400 ng/ml、SA测定值590 μg/ml为阳性参考值,测定肝癌组患者阳性率分别为57.57%、68.09%和35.7%.三者假阳性率分别为48%、20%和0,以AFP和SA对41例肝癌进行联合检测,其肝癌患者阳性检出率为80.49%.肝癌患者血清sIL-2R水平与肝硬化患者及肝炎患者比较无显著差异,P＞0.05.肝癌患者血清HGF水平低于肝硬化患者以及重症肝炎患者.结论肝癌患者HGF、sIL-2R和AFU显著高于正常人血清,但其升高的水平受肝脏炎症影响较大,对肝癌的特异性较差,因而不适合应用于肝炎肝硬化患者肝癌的诊断.AFP仍然是最敏感的肝癌血清指标,SA具有肿瘤特异性高和不受肝脏炎症干扰的特点,适合肝炎肝硬化患者肝癌的诊断,联合AFP可以使阳性检出率达80.49%,使肝癌的诊断灵敏性大大提高.     

Serum midkine is a more sensitive predictor for hepatocellular carcinoma than Dickkopf-1 and alpha-L-fucosidase in cirrhotic HCV patients

Alpha fetoprotein (AFP) level is the gold standard diagnostic tool for detection and monitoring hepatocellular carcinoma (HCC) but with low sensitivity. Thus, the identification of alternative or combined serum markers of HCC is highly needed. Therefore, the aim of this work was to verify the value of serum midkine (MDK), Dickkopf-related protein 1 (DKK1), and alpha-L-fucosidase (AFU) in detection of HCC.We recruited 244 subjects to the present study; 89 with liver cirrhosis, 86 cirrhotic hepatitis C virus (HCV) induced HCC, and 69 apparently healthy volunteers as controls. Serum AFP, MDK, DKK1, and AFU were measured by ELISA.Patients with HCC showed significantly higher serum MDK, DKK1, and AFU levels compared with those patients with liver cirrhosis and healthy controls (X² = 179.56, 153.94, and 90.07 respectively) (P < .001 in all). In HCC cases, neither of MDK, DKK1, or AFU was correlated with tumor number. On the other hand, only serum DKK1 was significantly higher in lesions >5 cm, those with portal vein thrombosis and advanced HCC stage. Receiver operator characteristic (ROC) curve analysis showed that serum MDK levels discriminated between cirrhosis and HCC at a sensitivity of 100%, a specificity of 90% at cut-off value of >5.1 ng/mL.Although our results showed that serum MDK, DKK-1, and AFU are increased in HCC cases only MDK may be considered as the most promising serological marker for the prediction of the development of HCC in cirrhotic HCV patients.     

Diagnostic significance of the determination of serum alpha-L-fucosidase in primary hepatocellular carcinoma

The results of determination of serum alpha-L-fucosidase (AFU) in healthy individuals, in patients with various liver diseases and non-liver malignant diseases were reported. In primary hepatic carcinoma the level of serum AFU was significantly higher than that in various other diseases and healthy persons (P less than 0.001). The serum AFU level was independent of AFP level (x = 1.24, P greater than 0.25). These data suggest that AFU may be a useful marker for the diagnosis of primary hepato cellular carcinoam with negative AFP.     

Value of circulating cell-free DNA in diagnosis of hepatocelluar carcinoma

AIM:To investigate the value of combined detection of circulating cell-free DNA(cfDNA),a-fetal protein(AFP) and a L-fucosidase(AFU) for diagnosis of hepatocellular carcinoma(HCC).METHODS:Serum samples from 39 HCC patients and 45 normal controls were collected.Branched DNA(bDNA) was used to detect the level of cfDNA,and a receiver operating characteristic curve was employed to evaluate the diagnostic sensitivity,specificity,accuracy,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio and Youden index,and to assess the diagnostic efficiency and their correlations with the clinicopathological features.AFP and AFU were detected by chemiluminescence and colorimetry,respectively.The significance of combined detection of the three biomarkers was discussed.RESULTS:cfDNA level was increased in 22 of the 39 HCC samples and in 2 of the 45 normal controls.cfDNA level in HCC samples was significantly higher than that in normal controls(P < 0.05).There were significant differences in sex and extra-and intrahepatic metastasis(P < 0.05).There was no significant correlation between cfDNA,AFP and AFU in the detection of HCC.The sensitivity of combined detection of cfDNA with one marker(AFP or AFU) and cfDNA with two markers(AFP and AFU) was 71.8%,87.2% and 89.7% vs 56.4%,53.8% and 66.7% for cfDNA,AFP and AFU used alone,respectively,the difference being statistically significant(P < 0.05).CONCLUSION:Quantitative analysis of cfDNA is sensitive and feasible,and the combined detection of cfDNA with AFP or AFU or both could improve the diagnostic sensitivity for HCC.     

血清高尔基蛋白73、甲胎蛋白异质体3、甲胎蛋白和α-L-岩藻糖苷酶水平诊断原发性肝癌的效能分析*

目的 探讨应用血清高尔基蛋白体73（GP73）、甲胎蛋白异质体3（AFP-L3）、AFP和α-L-岩藻糖苷酶（AFU）水平诊断原发性肝癌（PLC）患者的效能。方法 2015年1月~2017年3月我院诊治的PLC患者261例,乙型肝炎肝硬化患者201例,慢性乙型肝炎患者238例和体检健康人200例,采用酶联免疫吸附试验法检测血清GP73水平,采用亲和吸附离心管法检测血清AFP-L3,采用全自动化学发光仪检测血清AFP,采用商用试剂盒检测血清AFU水平。绘制血清GP73、AFP-L3、AFP和AFU诊断PLC的ROC曲线,确定截断点（cut-off-value）,计算ROC曲线下面积（AUC）,判断它们的诊断效能。结果 肝癌组血清GP73水平显著低于慢性肝炎组和肝硬化组,差异有统计学意义（P<0.05）,血清AFP-L3显著高于其他3组,差异有统计学意义（P<0.05）,血清AFU水平显著高于健康人和肝硬化组,但低于慢性肝炎组,差异有统计学意义（P<0.05）;以非肝癌人群为对照,血清GP73、AFP-L3、AFP和AFU诊断肝癌的ROC曲线下面积分别为0.564（95%CI：0.485~0.636）、0.724（95%CI：0.555~0.786）、0.745（95%CI：0.654~0.806）和0.571（95%CI：0.385~0.536）,血清AFP-L3联合AFP诊断肝癌的截断点分别为8.25%和49.25 ng/ml,其灵敏度（Se）为55.5%,特异度（Sp）为85.0%,正确性（Ac）为80.1%,显著高于血清AFP-L3诊断的55.5%、85.0%和76.4%或AFP诊断的57.1%、82.7%和75.2%（P<0.05）;在261例肝癌患者中,血清AFP<9.6 ng/ml者71例（27.2%),其中PG73>106.5 ng/ml者30例（42.3%）,提示GP73对AFP阴性肝癌有一定的诊断价值;在201例肝硬化患者中,血清AFP<9.6 ng/ml者98例（48.8%）,其中PG73>106.5 ng/ml者52例（53.1%）,提示血清GP73水平容易受到肝硬化的影响。结论 应用血清AFP联合AFP-L3检测能够提高诊断肝癌的效能,但它们的灵敏度都还不够高,影响因素较多。临床医生需结合病史、影像学检查和动态血清学检测才能做出更为科学的结论。     

Usefulness of serum alpha-fetoprotein (AFP) as a marker for hepatocellular carcinoma (HCC) in hepatitis C virus related cirrhosis: analysis of the factors influencing AFP elevation without HCC development]

BACKGROUND/AIMS: Serum alpha-fetoprotein (AFP) is frequently used for the diagnosis of hepatocellular carcinoma (HCC). Most available data concerning AFP came from studies of patients with chronic hepatitis B or mixed etiologies. Studies concerning the diagnostic value of AFP for HCV-related liver cirrhosis (LC) are limited. We evaluated the factors influencing AFP elevation in the absence of HCC and analyzed the diagnostic value of serum AFP in HCC surveillance of HCV-related LC patients. METHODS: We enrolled 55 patients of HCV-related LC with HCC and 62 patients without HCC as a case-control study were analyzed. The sensitivity and specificity were calculated and the clinical and biochemical factors influencing serum AFP levels. RESULTS: The sensitivities and specificities of serum AFP for the detection of HCC in HCV-related LC were 72.7% and 59.7% for AFP>or=20 ng/mL, and 47.3% and 92.5% for AFP>or=100 ng/mL, respectively. Elevated serum AST was independently associated with elevated serum AFP level in HCV-related LC. In cases of ASTor=100 ng/mL for the diagnosis of HCC was 100%. However, in case of AST>2 ULN, the specificity was 85.0% for AFP>or=100 ng/mL and 95.0% for AFP>or=200 ng/mL. CONCLUSIONS: Serum AST levels influence serum AFP level in HCV-related LC. In cases of AST2 ULN.     

Serum ferritin in hepatocellular carcinoma

The serum ferritin level was detected by radioimmunoassay in 142 patients with hepatocellular carcinoma (HCC). Serum ferritin level was raised (greater than ng/ml) in 38% (54/142) of patients with HCC. There was no difference in serum ferritin levels between stages 1, 2 and 3 HCC. None of the 4 patients with stage 1 HCC had serum ferritin levels above 300 ng/ml. In this small group of patients, measurement of serum ferritin was not a satisfactory indicator of stage 1 HCC. A combination of serum ferritin alpha fetoprotein (AFP) measurements may be useful for a rising suspicion of HCC. We found that a correct diagnosis of HCC was made in 38% (54/142) of patients by measurement of ferritin alone, and in 83.8% (119/142) by measurement of AFP alone, but in 92.3% (131/142) by measurement of a combination of these two markers. Serum ferritin estimation may be helpful in detection of HCC without elevated AFP. Among 12 cases of HCC with serum AFP less than 500 ng/ml, 6 cases (50%) had serum ferritin levels greater than ng/ml. There was no correlation between serum ferritin and AFP, nor between serum ferritin and HBsAg. However, among 12 patients with very high ferritin levels (range 992-3000 ng/ml), 11 (91.7%) had AFP levels of more than 500 ng/ml (mean = 4800 ng/ml, range 500-32000 ng/ml).     

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。