血清高尔基体糖蛋白73与MIF水平联合检测对原发性肝癌的诊断和预后价值研究

目的　探讨联合高尔基体糖蛋白73（golg glycoprotein, GP73），巨噬细胞移动抑制因子（migration inhibitory factor, MIF）诊断原发性肝癌(primary liver cancer, PLC) 以及预测原发性肝癌患者预后的价值。方法　选择2016 年1 月~2020 年1 月张家口市传染病医院肝病科收治的137 例原发性肝癌患者（肝癌组）、101 例肝良性肿瘤患者（肝良性肿瘤组）和109 例于门诊体检的健康志愿者（健康对照组）。检测血清GP73，MIF 水平，比较原发性肝癌不同病理特征和预后间血清GP73 和MIF 水平差异。Kaplan-Meier 法绘制不同GP73 和MIF 水平原发性肝癌患者生存曲线，受试者工作特征曲线（ROC）分析GP73 和MIF 诊断原发性肝癌以及预测原发性肝癌患者预后的价值。结果　肝癌组血清GP73（68.53±21.35 μg/L），MIF（123.35±20.48 pg/ml ）水平高于肝良性肿瘤组（13.42±6.52μg/L，43.02±7.61pg/ml）和健康对照组（13.13±6.25 μg/L，42.12±7.58 pg/ml），差异有统计学意义（t=25.081~39.309，均P ＜ 0.05）。TNM分期Ⅲ～Ⅳ期血清GP73（75.11±7.16μg/L），MIF（127.62±10.82 pg/ml）水平高于Ⅰ ~ Ⅱ期（54.15±10.42μg/L，114.02±12.05 pg/ml），差异有统计学意义（t=13.696，6.586，均P=0.000），死亡患者血清GP73（78.32±6.06 μg/L），MIF （130.12±6.03 pg/ml）水平高于存活患者（58.00±10.03μg/L，116.07±12.94 pg/ml），差异有统计学意义（t=14.467，8.239，均P ＜ 0.05）。 GP73 ≥ 68.53μg/L 组，MIF ≥ 123.35 pg/ml 组患者生存率34.29%（24/70），33.80%（24/71）]低于GP73 ＜ 68.53μg/L 组的62.69%（42/67） 和MIF ＜ 123.35 pg/ml 组的63.64%（42/66）（Log-Rankχ2=10.270，11.450，均P ＜ 0.05）。GP73，MIF 联合检测诊断原发性肝癌、预测原发性肝癌患者预后的曲线下面积分别为0.872，0.868，高于单独指标检测（均P ＜ 0.05）。结论　原发性肝癌患者血清GP73，MIF 水平均明显增高，且与TNM 分期和患者预后均存在一定关系，GP73，MIF 联合检测可为原发性肝癌诊断和预后预测提供参考。

Study on the Diagnostic and Prognostic Value of Serum Golgiglycoprotein 73 Combined with MIF Level in Primary Liver Cancer

Objective　 To investigate the value of combined with golgiglycoprotein73 (GP73) and macrophage migration inhibitory factor (MIF) in the diagnosis and prediction of prognosis of patients with primary liver cancer. Methods　From January 2016 to January 2020, 137 patients with primary liver cancer (liver cancer group) from Department of Liver Diseases, Zhangjiakou Infectious Diseases Hospital, 101 patients with benign liver tumor (benign liver tumor group) and 109 healthy volunteers who underwent physical examination in outpatient department (healthy control group) were selected. The levels of serum GP73 and MIF were detected, and the differences in coagulation four indices，serum GP73 and MIF levels were compared among different pathological features and prognosis of primary liver cancer. Kaplan-Meier method was used to draw survival curves of primary liver cancer patients with different GP73 and MIF levels. Receiver operating characteristic curve (ROC) was used to analyze the value of GP73 and MIF in the diagnosis and prediction of prognosis of patients with primary hepatocellular carcinoma. Results　The levels of serum GP73（68.53±21.35 μg/L）and MIF（123.35±20.48 pg/ml） in HCC group were higher than those in benign liver tumor group（13.42±6.52μg/L, 43.02±7.61pg/ml） and healthy control group(13.13±6.25μg/L, 42.12±7.58pg/ml) , the differences were statistically significant(t=25.081~39.309，all P<0.05). The levels of GP73（75.11±7.16μg/L） and MIF (127.62±10.82 pg/ml）in patients with TNM Ⅲ ~ Ⅳ stage were higher than those in patients with Ⅰ ～ Ⅱ stage（54.15±10.42μg/L，114.02±12.05pg/ml）, the differnces were statistically significant （t=13.696，6.586，all P<0.000）, and levels of GP73（78.32±6.06 μg/L） and MIF (130.12±6.03 pg/ml）patients with death were higher than those patients with survival （58.00±10.03μg/L,116.07±12.94pg/ml）, the differnces were statistically significant(t=14.467，8.239，all P<0.05). The survival rate of patients in GP73 ≥ 68.53μg/L group and MIF ≥ 123.35 pg/ml group was 34.29% (24/70) and 33.80% (24/71) respectively. That was lower than that of 62.69% (42/67) and 63.64% (42/66) in GP73 < 68.53μg/L group and MIF < 123.35 pg/ml group (log-RANKχ2 =10.270, 11.450, all P < 0.05).The area under the curve by combined with GP73 and MIF in the diagnosis and prediction of prognosis of patients with primary liver cancer were 0.872， 0.868, respectively, which were higher than those of the single index (P<0.05). Conclusion　The levels of serum GP73 and MIF in patients with primary liver cancer are significantly increased, and there is a certain correlation with TNM stage and prognosis. The combination of GP73 and MIF can provide reference for diagnosis and prediction of prognosis of primary liver cancer.