三种血清标志物联合检测在早期肝细胞肝癌中的诊断价值

目的 探讨血清高尔基体蛋白73(GP73)、α-L岩藻糖苷酶(AFU)和甲胎蛋白(AFP)联合检测对早期肝细胞癌(HCC)的诊断价值.方法 收集2016年3月至2017年3月该院肝病患者222例,根据疾病类型分为早期HCC组(74例)、晚期HCC组(27例)、肝硬化组(74例)、慢性乙型肝炎组(47例),另选取同期体检健康者49例作为健康对照组.分别测定各组血清AFP、AFU和GP73水平,绘制受试者工作特征(ROC)曲线,评价3项指标单独和联合检测对早期HCC的诊断价值.结果 早期HCC组GP73、AFU和AFP水平均明显高于肝硬化组、慢性乙型肝炎组和健康对照组(P＜0.05).在肝癌筛查时,AFP单独诊断的ROC曲线下面积(AUC)为0.910(95％CI:0.864～0.936),两项指标联合时GP73和AFP联合诊断的AUC最大[0.925(95％CI:0.889～0.950)],灵敏度最高(95.0％).在鉴别诊断早期HCC与肝硬化时,单独诊断以GP73的AUC最大[0.842(95％CI:0.746～0.879)],特异度最高(86.5％);两项指标联合时GP73和AFU联合诊断的AUC最大[0.901(95％CI:0.788～0.907)].结论 GP73与AFP联合检测可以提高HCC筛查的诊断效能,GP73和AFU联合诊断能够提高早期HCC诊断效能,对于早期HCC和肝硬化的鉴别诊断具有重要意义.

Diagnostic value of GP73, AFP and AFU combined detection in early hepatocelluar carcinoma

Objective To evaluate the diagnostic value of combination detection of alpha-fetoprotein (AFP),Golgi protein 73 (GP73) and a-L-fucosidase (AFU) for early hepatocellular carcinoma (HCC).Methods A total of 222 patients with liver diseases in this hospital from March 2016 to March 2017 were collected and divided into the early stage HCC group (74 cases),late stage HCC group (27 cases),liver cirrhosis group (74 cases) and chronic hepatitis B group (47 cases),and contemporaneous 49 individuals undergoing physical examination were selected as the healthy control group.The levels of serum GP73,AFP and AFU were detected in each group.The ROC curve was drawn.The diagnostic values of single detection and combined detection of 3 indicators for diagnosing early HCC were evaluated.Results The serum GP73,AFP and AFU levels in the early stage HCC group were significantly higher than those in the liver cirrhosis group,chronic hepatitis B group and healthy control group (P＜0.05).In the HCC screening,the area under the curve (AUC) of AFP ROC curve for singly diagnosing HCC was 0.910(95％CI:0.864-0.936),AUC of GP73 and AFP combined diagnosis was maximal [0.925 (95％ CI:0.889-0.950)] and the sensitivity was the highest (95.0％).In the differentiation diagnosis between early HCC and liver cirrhosis,AUC of GP73 for single diagnosis was maximal [0.842(95％CI:0.746-0.879)] and the specificity was the highest (86.5％);AUC of GP73 and AFU combined diagnosis was maximal[0.901(95％CI:0.788-0.907)].Conclusion GP73 and AFP for combined detection of HCC can increase the diagnostic efficiency of HCC screening.GP73 and AFU combined diagnosis can increase the diagnosis efficiency of early HCC,which has an important significance for the differentiation diagnosis between early HCC and liver cirrhosis.