甲胎蛋白异质体在鉴别良恶性肝病中的临床应用

目的:探讨小扁豆凝集素结合型甲胎蛋白异质体(AFP-L3)在良恶性肝病鉴别诊断中的临床价值。方法:应用装有耦联了小扁豆凝集素(LCA)的微量离心柱分离131例肝病患者的AFP-L3,用化学发光免疫检测血清AFP和AFP-L3含量,计算AFP-L3占AFP总量的百分比(AFP-L3%)。结果:与肝硬化(LC)和慢性肝炎(CH)组相比,肝癌(HCC)组中患者血清AFP、AFP-L3与AFP-L3%均升高,经Kruskal-Wallis秩和检验有统计学意义(χ2=31.457,41.983,41.377;P=0.000,0.000,0.000)。AFP、AFP-L3和AFP-L3%相应ROC曲线下面积(AUC)分别为0.628、0.718和0.795,其差异均有统计学意义(P<0.05)。以AFP-L3%≥6.90%判断为阳性,AFP-L3%诊断肝细胞癌敏感性和特异性分别为66.7%和82.4%。结论:AFP-L3对肝细胞癌诊断准确度明显高于AFP,微量离心柱法检测AFP-L3在良恶性肝脏病变鉴别诊断中具有重要临床价值。

Clinical application of alpha-fetoprotein variant to screening benign and mlaignant liver dis-eases

Objective：To verify the clinical value of applying the isoform of alpha -fetoprotein variant（AFP-L3） to screening benign and malignant liver diseases.Methods：AFP-L3 was isolated 131 patients with liver disease using the micro-spin column coupled with lens culinaris agglutinin （ LCA） .Chemi-luminescent immunoassay was performed to determine the content of serum AFP and AFP-L3,and AFP-L3% was calculated.Results：The serum levels of AFP and AFP-L3 as well as AFP-L3% were significantly higher in patients with hepatocellular carcinoma （HCC） compared to patients with liver cirrhosis （LC） and chronic hepatitis （CH）,and Kruskal-Wallis one-way analysis of the variance showed statistical difference （χ^2 =31.457,41.983,41.377;P=0.000,respectively）.The area under the ROC curve （AUC） of AFP,AFP-L3 and AFP-L3 % was 0.628,0.718 and 0.795,respectively,and the differ-ences were significant （P〈0.05）.Sensitivity and specificity by AFP-L3 %（≥6.90% cut-off value） for diagnosis of HCC were66 .7% and 82.4%. Conclusion：Accuracy by AFP-L3 level measurement may excel the simple AFP in diagnosis of HCC ,and AFP-L3 determination by micro-spin column as-say can have clinical implications for differential diagnosis of HCC .