血清肿瘤标志物的联合动态检测在原发性肝癌诊断中的价值

目的 探讨血清肿瘤标志物甲胎蛋白（AFP）、恶性肿瘤特异性生长因子（TSGF）、高尔基体膜蛋白73（GP73）、骨桥蛋白（OPN）联合动态检测在原发性肝癌诊断中的应用价值.方法 选取122例原发性肝癌患者、50例肝脏良性病变患者和50名健康体检者为研究对象,采用电化学发光法检测其血清AFP、TSGF、GP73水平,酶联免疫吸附试验法（ELISA）检测OPN水平,分析血清肿瘤标志物AFP、TSGF、GP73和OPN在原发性肝癌诊断中的临床应用价值.结果 原发性肝癌患者血清AFP、TSGF、GP73和OPN水平明显高于肝脏良性病变患者和健康对照者,差异均有统计学意义（均P＜0.01）;原发性肝癌患者血清肿瘤标志物水平与患者年龄、性别无关（均P＞0.05）,与病灶大小、肿瘤数目、临床分期、腹腔积液、肝硬化、门静脉侵犯、转移、复发、治疗后相关（均P＜0.05）.AFP、TSGF、GP73和OPN单项用于诊断原发性肝癌的敏感度分别为57.38％、68.85％、70.49％、69.67％;AFP＋TSGF、AFP＋TSGF＋GP73的敏感度分别为80.33％、85.25％;4项肿瘤标志物联合检测可使敏感度提高到98.36％,准确度提高到95.65％,与各单项及部分组合检测比较差异均有统计学意义（均P＜0.05）.结论 血清肿瘤标志物AFP、TSGF、GP73和OPN可作为诊断原发性肝癌的辅助手段,4项肿瘤标志物联合检测的敏感性及准确性明显提高,从而减少误诊、漏诊,有利于肝癌的早期诊断、临床早期干预.

The value of dynamic combined detection of serum tumor biomarkers in diagnosing primary hepatic carcinoma

Objective To investigate the value of combined detection of serum tumor biomarkers including alpha-fetoprotein （AFP）,tumor specific growth factor （TSGF）,golgi protein 73 （GP73） and osteopontin （OPN） in diagnosis of primmy hepatic carcinoma.Methods AFP,TSGF and GP73 levels were measured by electro-chemiluminescence immunoassay,and OPN levels by enzyme-linked immunosorbent assay （ELISA） in 122 cases of primary hepatic carcinoma,50 cases of liver benign lesions and 50 cases of healthy control.The biological parameters and the levels of AFP,TSGF,GP73 and OPN were studied.Results The serum levels of AFP,TSGF,GP73 and OPN in primary hepatic carcinoma were higher than those in the liver benign disease group and the normal control group （all P 〈 0.01）.Sex and age of the patients at diagnosis showed no significant association with the levels of the four serum tumor biomarkers in the primary hepatic carcinoma groups （all P 〉 0.05）.But the tumor size,amount,tumor stage,metastasis and recurrence showed significant association with the levels of those in the primary hepatic carcinoma groups （all P 〈 0.05）.The sensitivity,specificity and veracity of serum AFP,TSGF,GP73 and OPN as individual diagnostic marker was only 57.38 %,68.85 %,70.49 % and 69.67 %,respectively.The sensitivity of combined detection of AFP and TSGF was 80.33 %,and that of combined detection of AFP,TSGF and GP73 was 85.25 %.While,the sensitivity of the four serum tumor markers in combination was 98.36 %,the accuracy was 95.65 %.The sensitivity and accuracy of combined detection with the four serum tumor markers were significantly higher than those of the individual markers and other combination detection methods （all P 〈 0.05）.Conclusions Serum markers of AFP,TSGF,GP73 and OPN can serve as a means for diagnosis of primary hepatic carcinoma.Combined detection of the four serum tumor biomarkers can improve the sensitivity,accuracy and the negative predictive value,which is benefit to early diagnosis and interference.