高尔基体蛋白73对肝癌高风险人群的诊断与鉴别诊断价值

目的 检测肝癌、肝硬化、肝炎患者及健康体检者血清高尔基体蛋白73（GP73）、甲胎蛋白（AFP）、甲胎蛋白异质体-3（AFP-L3）水平,探讨GP73在肝癌高风险人群中的早期诊断价值.方法 选取肝癌患者64例（肝癌组）,肝硬化患者60例（肝硬化组）,肝炎患者53例（肝炎组）及健康体检者51例（对照组）,酶联免疫吸附试验法检测各组GP73水平,AFP-L3亲和吸附离心管洗脱获得AFP-L3,化学发光法检测总AFP和AFP-L3,计算AFP-L3占总AFP的比例.结果 肝癌组血清GP73、AFP、AFP-L3阳性率均明显高于肝硬化组、肝炎组78.1％（50/64）比25.0％ （15/60）、17.0％（9/53）,48.4％（31/64）比31.7％（19/60）、22.6％（12/53）,53.1％ （34/64）比30.0％（18/60）、20.8％（11/53）],差异均有统计学意义（P＜0.05）.对照组GP73、AFP、AFP-L3均未见阳性.肝癌组血清GP73、AFP、AFP-L3水平明显高于肝硬化组、肝炎组及对照组（245.69±89.18） μg/L比（116.37±38.52）、（97.29±24.58）、（23.48±9.12） μg/L,（403.27±128.46） μg/L比（75.62±19.35）、（66.49±15.14）、（3.46±1.02） μg/L,（15.64±3.19）％比（5.24±1.15）、（4.21±0.96）、（2.95±0.73）％],差异均有统计学意义（P＜0.05）.肝硬化组和肝炎组GP73、AFP高于对照组,差异均有统计学意义（P＜0.05）.肝硬化组和肝炎组GP73、AFP、AFP-L3水平比较差异无统计学意义（P＞0.05）.三项联合检测诊断肝癌的敏感度和准确度分别为96.9％（62/64）、91.7％（209/228）,明显高于AFP、AFP-L3单项检测,差异均有统计学意义（P＜0.05）,与GP73单项检测及任意两项联合检测比较差异无统计学意义（P＞0.05）.不同性别、年龄、肿瘤直径、AFP水平、临床分期的肝癌患者血清GP73水平比较差异无统计学意义（P＞0.05）；乙型肝炎病毒表面抗原是否阳性及有无肝外转移和肝硬化的肝癌患者血清GP73水平比较差异有统计学意义（P＜0.05）.结论 GP73诊断肝癌的价值明显高于AFP和AFP-L3,联合检测有助于肝癌高风险人群的筛查.

Diagnostic value of serum Golgi membrane protein 73 in populations with high risk of primary hepatic carcinoma

Objective To explore the early diagnostic value of Golgi membrane protein 73 （GP73）,alpha-fetoprotein （AFP） and alpha-fetoprotein-L3 （AFP-L3） in patients with high risk of primary hepatic carcinoma （PHC）.Methods Sixty-four cases of PHC were selected as the PHC group,60 cases of liver cirrhosis（LC） as the LC group,53 cases of hepatitis as the hepatitis group and 51 healthy checked-up people as the control group.Enzyme-linked immunosorbent assay （ELISA） was used to detect the serum level of GP73 in all the cases.AFP-L3 was isolated by using affinity micro centrifugal column,AFP and AFP-L3 were detected with chemiluminescent immunoassay and then the proportion of AFP-L3 was calculated.Results The positive rate of serum GP73,AFP and AFP-L3 in PHC group was significantly higher than that in LC group and hepatitis group 78.1% （50/64）vs.25.0% （15/60）,17.0% （9/53）;48.4% （31/64） vs.31.7% （19/60）,22.6%（12/53） ;53.1%（34/64） vs.30.0%（18/60）,20.8%（11/53）] （P 〈 0.05）,In control group,GP73,AFP,AFP-L3 was no positive.The levels of GP73,AFP and AFP-L3 in PHC group were significantly higher than those in LC group,hepatitis group and control group （245.69 ± 89.18）μ g/L vs.（116.37 ±38.52）,（97.29 ± 24.58）,（23.48 ±9.12） μ g/L; （403.27 ± 128.46） μg/L vs.（75.62 ± 19.35）,（66.49 ± 15.14）,（3.46 ± 1.02） μg/L; （15.64 ±3.19）% vs.（5.24 ± 1.15）,（4.21 ± 0.96）,（2.95 ±0.73）%] （P 〈0.05）.The levels of GP73,AFP in LC group and hepatitis group were significantly higher than those in control group （P 〈 0.05）.The levels of GP73,AFP and AFP-L3 had no statistically significant difference between LC group and hepatitis group （P 〉 0.05）.Sensitivity and accuracy of three combined detection for PHC was 96.9%（62/64）,91.7%（209/228）,significantly higher than that of AFP,AFP-L3 single detection （P 〈 0.05）.GP73 single detection and any two combined detection was no significant difference in sensitivity and accuracy,compared with three combined detection （P 〉 0.05）.The levels of GP73 in PHC patients with different age,gender,serum level of AFP,TNM stage and tumor diameter had no statistically significant difference （P 〉 0.05）.The levels of GP73 in PHC patients with positive HBsAg,extrahepatic metastases and LC had significant difference （P 〈 0.05）.Conclusions The diagnosis value of GP73 is evidently higher than AFP and AFP-L3 for PHC,and combined determination is superior to single marker.Combined determination enhances the degree of precision in populations with high risk of PHC diagnosis.