血清甲胎蛋白对原发性肝细胞癌诊断价值的再评价

目的评价血清甲胎蛋白（alpha-fetoprotein,AFP）对原发性肝细胞癌（hepatocellular carcinoma,HCC）的诊断价值。方法以病理确诊的HCC185例及肝炎肝硬化125例为研究对象,AFP测定采用微粒子酶联免疫法。将AFP测定值连续划分为9个数据段,计算敏感度、特异度、阳性似然比、阴性似然比、诊断优势比及准确度。应用SPSS16.0统计软件绘制受试者工作曲线（ROC）,确定最适合临界值。Kaplan-Meier生存曲线分析不同AFP水平患者的生存率。结果 AFP Cut-off值为20μg/L时敏感度最高,为54.6%;400μg/L时特异度最高,为97.6%;250μg/L时,阳性似然比、特异度及诊断优势比均为最高,分别为12.838、97.6%及18.109,ROC曲线下面积最大,为0.722。AFP水平与年龄、性别、ALT水平、Child分级及HBeAg阳性与否无关。AFP〈20μg/L的HCC患者2年生存率高于AFP≥20μg/L的患者（P〈0.05）,对于AFP〈20μg/L的患者,手术治疗1年生存率高于非手术治疗（P〈0.05）。结论对于HCC的诊断,AFP为250μg/L时效能最高。AFP水平与HCC患者预后有关。

Re-evaluation of the diagnostic value of serum AFP for patients with primary hepatocellular carcinoma

Objective To re-evaluate the diagnostic value of sera AFP for primary hepatocellular carcinoma（HCC）.Methods 185 patients with HCC histopathologically confirmed and 125 patients with cirrhosis were included.Sera AFP was detected with microparticle enzyme-linked immunosorbent assay.Cut-off values of AFP were divided into 9 sequent levels.The sensitivity,specificity,positive and negative likelihood ratio（LR＋,LR-）,diagnostic odd ratio（dOR） and accuracy were calculated with 2×2 table.Receiver operator characteristic curve（ROC） was presented with SPSS16.0 software.The diagnostic value of AFP for HCC was determined with above evaluation indexes.Kaplan-Meier survival curve analysis of survival in patients with different levels of AFP was made.Results The sensitivity was 54.6% for diagnosis of HCC as cut-off value of AFP was 20μg/L,was the highest one in all of the cutoff value.and the specificity was 97.6% as AFP was 400μg/L,was the highest one in all of the cutoff value.The LR＋,specificity and dOR was the highest as AFP was 250μg/L,the LR＋,specificity and dOR were 12.838,97.6% and 18.109.It had the largest area under the ROC curve,which was 0.722.The best diagnostic value of AFP for HCC was 250μg/L.No correlation was observed between the level of serum AFP and clinical information of the patient,including sex,gender,level of ALT,Child degree of hepatic function and whether HBeAg positive or not.The 2-years survival rate in HCC patients with AFP20μg/L was higher than the patients with AFP≥20μg/L（P0.05）.For the patients with AFP 20μg/L,1-year survival rate of surgical treatment was higher than that of non-surgical treatment（P0.05）.Conclusions It is suggested that 250μg/L of AFP seems a suitable diagnostic cut-off value for HCC.There exists the relationship between serum AFP and survival in HCC patients.