摘要
目的 研究血清甲胎蛋白、异常凝血酶原(PIVKA-Ⅱ)、γ-谷氨酰转移酶(GGT)、GGT/丙氨酸氨基转移酶(GGT/ALT)在早期原发性肝癌诊断中的临床价值.方法 研究方法为前瞻性分析,观察对象为2020年1月至2023年1月攀枝花市中西医结合医院的80例疑似早期原发性肝癌患者,将细胞学、病理学活检诊断结果作为本次研究的金标准划分两组,分别命名为恶性组(n=53)与良性组(n=27).分别采集血液样本检测血清甲胎蛋白、PIVKA-Ⅱ、GGT、ALT水平,并计算GGT/ALT比值;比较两组患者血清甲胎蛋白、PIVKA-Ⅱ、GGT、GGT/ALT表达水平.比较两组患者血清甲胎蛋白、PIVKA-Ⅱ、GGT、GGT/ALT阳性情况.所有患者均进行细胞学、病理学活检,分析血清甲胎蛋白、PIVKA-Ⅱ、GGT、GGT/ALT单一指标、联合指标诊断原发性肝癌与病理学诊断结果的一致性.采用受试者工作特征(ROC)曲线评估血清甲胎蛋白、PIVKA-Ⅱ、GGT、GGT/ALT 4项指标单一与联合对原发性肝癌的诊断效能.结果 恶性组患者的血清甲胎蛋白、PIVKA-Ⅱ、GGT、GGT/ALT 表达水平分别为(1 118.82±67.85)ng/mL、(582.43±197.17)mAU/mL、(102.06±9.47)U/L、3.19±1.71,均明显高于良性组[(9.30±4.76)ng/mL、(31.18±7.34)mAU/mL、(71.64± 21.98)U/L、1.61±0.64],差异均有统计学意义(P＜0.05).恶性组患者血清甲胎蛋白、PIVKA-Ⅱ、GGT、GGT/ALT单一及联合指标阳性率分别为73.58％、88.68％、100.00％、54.72％、100.00％,均明显高于良性组(40.74％、14.81％、70.37％、18.52％、33.33％),差异均有统计学意义(P＜0.05).血清甲胎蛋白与组织病理学诊断之间的一致性系数Kappa=0.320(P=0.004),血清PIVKA-Ⅱ与组织病理学诊断之间的一致性系数Kappa=0.725(P＜0.001),血清GGT与组织病理学诊断之间的一致性系数Kappa=0.358(P＜0.001),血清GGT/ALT与组织病理学诊断之间的一致性系数Kappa=0.309(P=0.002),联合诊断与组织病理学诊断之间的一致性系数Kappa=0.385(P=0.001).ROC曲线显示,甲胎蛋白、PIVKA-Ⅱ、GGT、GGT/ALT诊断早期原发性肝癌的曲线下面积(AUC)分别为0.842、0.943、0.908、0.899、0.997.结论 在早期原发性肝癌诊断中,血清PIVKA-Ⅱ水平检测的诊断价值优于甲胎蛋白、GGT、GGT/ALT,AFP、PIVKA-Ⅱ、GGT、GGT/ALT 4项指标联合检测的价值优于单一指标检测.
Abstract
Objective To investigate the clinical value of serum alpha-fetoprotein,protein induced by vitamin K absence or Antagonist-Ⅱ(PIVKA-Ⅱ),gamma-glutamyltransferase(GGT),GGT/alanine aminotransferase(GGT/ALT)in the diagnosis of early primary liver cancer.Methods The study method was a prospective analysis.The observation objects were 80 patients with suspected early primary liver canc-er in Panzhihua Hospital of Integrated Chinese and Western Medicine from January 2020 to January 2023.The cytological and pathological biopsy diagnostic results were used as the gold standard for this study and divided into two groups,named malignant group(n=53)and benign group(n=27).Blood samples were collected to detect serum alpha-fetoprotein,PIVKA-Ⅱ,GGT and ALT levels,and the GGT/ALT ratio was calculated,the expression levels of serum alpha fetoprotein,PIVKA-Ⅱ,GGT,and GGT/ALT were compared between two groups of patients.The serum levels of alpha fetoprotein,PIVKA-Ⅱ,GGT,and GGT/ALT were compared between two groups of patients.All patients underwent cytology and pathological biopsy,and the consistency between serum alpha fetoprotein,PIVKA-Ⅱ,GGT,GGT/ALT single and combined indi-cators in diagnosing primary liver cancer and pathological diagnosis results was analyzed.The diagnostic efficacy of single and combined serum al-pha fetoprotein,PIVKA-Ⅱ,GGT,and GGT/ALT in primary liver cancer was evaluated using receiver operating characteristic(ROC)curves.Results The expression levels of serum alpha-fetoprotein,PIVKA-Ⅱ,GGT and GGT/ALT in the malignant group were(1 118.82±67.85)ng/mL,(582.43±197.17)mAU/mL,(102.06±9.47)U/L,3.19±1.71,which were significantly higher than those in the benign group[(9.30±4.76)ng/mL,(31.18±7.34)mAU/mL,(71.64±21.98)U/L,1.61±0.64],the differences were statistically significant(P＜0.05).The positive rates of serum alpha fetoprotein,PIVKA-Ⅱ,GGT,GGT/ALT single and combined indicators in the malignant group were 73.58％,88.68％,100.00％,54.72％,and 100.00％,respectively,which were significantly higher than those in the benign group(40.74％,14.81％,70.37％,18.52％,and 33.33％),and the differences were statistically significant(P＜0.05).The coefficient of consistency be-tween serum AFP and histopathological diagnosis was Kappa=0.320(P=0.004),and the coefficient of consistency between serum PIVKA-Ⅱand histopathological diagnosis was Kappa=0.725(P＜0.001).The coefficient of consistency between serum GGT and histopathological diagno-sis was Kappa=0.358(P＜0.001),the coefficient of consistency between serum GGT/ALT and histopathological diagnosis was Kappa=0.309(P=0.002).The coefficient of agreement between combined diagnosis and histopathological diagnosis was Kappa=0.385(P=0.001).The ROC curve showed that the area under the curve(AUC)of alpha fetoprotein,PIVKA-Ⅱ,GGT,and GGT/ALT for diagnosing early primary liver cancer were 0.842,0.943,0.908,0.899,and 0.997,respectively.Conclusion In the early diagnosis of primary liver cancer,the diagnostic value of se-rum PIVKA-Ⅱ level detection is better than AFP,GGT,GGT/ALT,and the value of combined detection is better than single index detection.
基金项目
四川省卫生和计划生育委员会科研课题(17PJ428)
NETL
NSTL
维普
万方数据