血清生长分化因子15和甲胎蛋白联合检测对HBV相关肝细胞癌的诊断价值

目的探讨血清生长分化因子15(GDF15)和AFP联合检测对诊断HBV感染相关肝细胞癌(HCC)的临床价值。方法选取2019年3月1日-2019年9月1日在武汉大学人民医院诊治的患者和健康体检者共225例,其中HBV感染导致的HCC患者(HCC组)97例,慢性乙型肝炎患者(CHB组)41例,健康体检者(NC组)87例,分别测定三组人群的GDF15和AFP水平。计量资料采用单样本Kolmogorov-Smirnov法检验各组数据是否符合正态性,正态分布资料多组间比较采用方差分析,进一步两两比较采用LSD-t检验;非正态分布资料多组间比较采用Kruskal-Wallis H检验,两两比较采用Mann-Whitney U检验。计数资料采用χ2检验。采用二元logistic回归分析得到GDF15和AFP联合的回归模型,并绘制GDF15和AFP单独或联合检测的ROC曲线,计算曲线下面积及灵敏度、特异度和约登指数。结果HCC组、CHB组和NC组的GDF15和AFP水平差异均有统计学意义(χ2值分别为53.77、119.12,P值均<0.01);HCC组GDF15水平明显高于CHB组和NC组(P值均<0.01);HCC组和CHB组AFP水平均显著高于NC组,且HCC组AFP水平显著高于CHB组,差异均有统计学意义(P值均<0.01)。ROC曲线分析显示,GDF15、AFP及二者联合诊断HCC的曲线下面积、灵敏度和特异度分别为0.752、74.0%和68.3%,0.660、45.8%和85.4%,0.816、88.4%和68.5%。结论GDF15和AFP联合检测可以提高HBV相关HCC的诊断性能,具有较高的临床价值。

Value of combined measurement of serum growth differentiation factor 15 and alpha-fetoprotein in the diagnosis of hepatitis B virus-related hepatocellular carcinoma

Objective To investigate the clinical value of combined measurement of serum growth differentiation factor 15(GDF15)and alpha-fetoprotein(AFP)in the diagnosis of hepatocellular carcinoma(HCC)associated with hepatitis B virus(HBV)infection.Methods A total of 225 subjects who received treatment or underwent physical examination in Renmin Hospital of Wuhan University from March 1 to September 1,2019,were enrolled,among whom there were 97 patients with HCC caused by HBV infection(HCC group),41 patients with chronic hepatitis B(CHB group),and 87 healthy individuals(NC group),and the levels of GDF15 and AFP were measured for all three groups.The one-sample Kolmogorov-Smirnov test was used to determine whether the data were normally distributed or not;an analysis of variance was used for comparison of normally distributed data between multiple groups,and the least significant difference t-test was used for further comparison between two groups;the Kruskal-Wallis H test was used for comparison of non-normally distributed data between multiple groups,and the Mann-Whitney U test was used for further comparison between two groups.The chi-square test was used for comparison of categorical data.A binary logistic regression analysis was used to obtain the regression model of GDF15 and AFP;the receiver operating characteristic(ROC)curve was plotted for GDF15 and AFP used alone or in combination,and the area under the ROC curve(AUC),sensitivity,specificity,and Youden index were calculated.Results There were significant differences in the levels of GDF15 and AFP between the HCC group,the CHB group,and the NC group(χ2=53.77 and 119.12,both P<0.01);the HCC group had a significantly higher level of GDF15 than the CHB group and the NC group(both P<0.01),the HCC group and the CHB group had a significantly higher level of AFP than the NC group,and the HCC group had a significantly higher level of AFP than the CHB group(all P<0.01).The ROC curve analysis showed that GDF15 alone had an AUC of 0.752,a sensitivity of 74.0%,and a specificity of 68.3%,AFP alone had an AUC of 0.660,a sensitivity of 45.8%,and a specificity of 85.4%,and GDF15 combined with AFP had an AUC of 0.816,a sensitivity of 88.4%,and a specificity of 68.5%.Conclusion Combined measurement of GDF15 and AFP can improve the diagnostic efficiency for HBV-related HCC and has a high clinical value.