甲胎蛋白异质体3及其比值对原发性肝癌和肝硬化的鉴别诊断价值研究

目的探讨甲胎蛋白异质体3(AFP-L3)及其比值对原发性肝癌(HCC)和肝硬化的鉴别诊断价值及诊断界值。方法应用AFP-L3快速分离微量离心柱分离40例HCC患者和65例肝硬化患者的AFP-L3,电化学发光免疫分析夹心法检测血清AFP水平,计算AFP-L3比值,即AFP-L3绝对值占血清AFP总量的百分比。结果HCC患者AFP-L3比值大于肝硬化患者,差异有统计学意义(F=57.433,P=0.000);AFP-L3比值诊断HCC的受试者工作特征曲线(ROC曲线)下面积最大,为0.916;AFP-L3比值≥15%时诊断HCC的敏感度和特异度之和最大,为177.1%。结论 AFP-L3比值对HCC的诊断效能优于AFP和AFP-L3,对肝硬化和HCC的鉴别诊断具有重要临床意义。

Value of Serum Alpha-fetoprotein Invariant AFP-L3 Assay in the Differential Diagnosis of Hepatocellular Carcinoma

Objective To investigate the role of serum alphafetoprotein variant(AFP-L3)assay in the differential diagnosis of hepatocellular carcinoma(HCC)and cirrhostic diseases.Methods AFP-L3 was separated from sera of AFP-positive patients(45 HCC patients and 60 cirrhotic patients) by micro-spin columns coupled with lens culinaris agglutinin(LCA).AFP was detected using electrochemiluminescence analysis to determine the amount of AFP-L3 and AFP-L3%(the ratio of AFP-L3 to total AFP).Results The AFP-L3% in HCC patients was significantly higher than that in patients with cirrhosis diseases(F=57.433,P=0.000).The area under curve of Receiver Operating Characteristic of AFP-L3 % was the highest(0.916).The sensitivity and specificity of AFP-L3 for HCC patients was 92.5 % and 84.6 % respectively,with AFP-L3%≥15% being the optimal diagnostic threshold.Conclusion AFP-L3(%)is more sensitive than the amounts of AFP and AFP-L3 in the diagnosis of HCC,and shows certain value in the differential diagnosis of HCC and cirrhosis diseases.