摘要
目的 探讨甲胎蛋白(AFP)、甲胎蛋白异质体比率(AFP-L3％)、异常凝血酶原(PIVKA Ⅱ)和热休克蛋白90α(HSP 90α)在乙型肝炎病毒(HBV)相关慢性肝病中的应用价值.方法 选择2021年1月～2023年12月于潍坊市人民医院就诊的慢性HBV感染者190例为研究对象,分为HBV相关肝细胞癌(HBV-HCC)组(n=86)和良性肝病组(n=104);以AFP检测上限7.0 μg/L进行亚组分析,＞7.0 μg/L为AFP阳性组,≤7.0μg/L为AFP阴性组;应用酶联免疫法检测血浆HSP 90α;应用免疫荧光法检测血清AFP、AFP-L3％和PIVKAⅡ.结果 ①HBV-HCC 组 AFP、AFP-L3％、PIVKA Ⅱ 和 HSP 90α 明显高于良性肝病组(P＜0.05);②HBV-HCC组和良性肝病组AFP均与AFP-L3％、HSP90α呈正相关(P＜0.05);③HBV-HCC组AFP与PIVKA Ⅱ呈正相关(r=0.469,P＜0.001),而良性肝病组AFP与PIVKA Ⅱ之间无相关性(P＞0.05);④亚组分析组内比较:两组的AFP阴性组 AFP、AFP-L3％、HSP 90α 均低于 AFP 阳性组(P＜0.05),HBV-HCC 组中 AFP 阴性组 PIVKA Ⅱ 低于 AFP阳性组(P＜0.001);⑤亚组分析组间比较:AFP阳性组中,良性肝病组AFP、AFP-L3％、PIVKA Ⅱ明显低于HBV-HCC 组(P＜0.05),HSP 90α表达量两组之间无统计学差异(P＞0.05),AFP阴性组中,AFP、AFP-L3％、PIVKAⅡ、HSP 90α的表达量均无明显差异(P＞0.05).结论 AFP、PIVKA Ⅱ、AFP-L3％可作为HBV-HCC早期诊断标志物,联合应用能提高诊断效能;而HSP 90α诊断效能不佳,不宜作为HBV-HCC早期诊断标志物;AFP-L3％可用于区分AFP升高的原因.
Abstract
Objective To investigate the clinical significance of alpha-fetoprotein(AFP),the percentage of lens culinaris agglutinin-reactive fraction of AFP(AFP-L3％),prothrombin induced by vitamin K absence-Ⅱ(PIVKAⅡ)and heat shock protein 90α(HSP-90α)in patients with hepatitis B virus(HBV)related chronic liver diseases.Methods A total of 190 patients with chronic HBV infection in Weifang People's Hospital from January 2021 to Decem-ber 2023 were enrolled.They divided into benign liver disease group(ni=104)and HBV associated HCC group(HBV-HCC group,n=86)according to the disease benign or malignant.Subgroup analyses were performed in both groups ac-cording to the normal upper limit of AFP(7.0 μg/L).Enzyme-linked immunosorbent assay was used to detect HSP-90αin plasma,and AFP,AFP-L3％and PIVKA Ⅱ in serum were detected by immunofluorescence assay.Results ①The levels of AFP,AFP-L3％,PIVKA Ⅱ and HSP 90α in HBV-HCC group were higher than those in benign liver disease group(P＜0.05).②AFP was positively correlated with AFP-L3％,HSP-90α in both HBV-HCC and benign liver disease groups(P＜0.05).③AFP was positively correlated with PIVKA Ⅱ(r=0.469,P＜0.001)in HBV-HCC group,however,there was no correlation between AFP and PIVKA Ⅱ(P＞0.05)in benign liver disease group.④In both HBV-HCC and benign liver disease groups,the levels of AFP,AFP-L3％and HSP 90α in AFP negative were significantly lower than those in AFP positive group(P＜0.05).In HBV-HCC group,the level of PIVKA Ⅱ in AFP negative group was signifi-cantly lower than that in AFP positive group(P＜0.001).⑤In AFP-positive patients,the levels of AFP,AFP-L3％and PIVKA Ⅱ in benign liver disease group were significantly lower than those in HBV-HCC group(P＜0.05),however,the level of HSP-90α was no significant difference between two groups(P＞0.05).In AFP-negative patients,the levels of AFP,AFP-L3％,PIVKA Ⅱ and HSP-90α in benign liver disease group were not significantly different from those in HBV-HCC group(P＞0.05).Conclusion AFP,PIVKA Ⅱ and AFP-L3％could be used as markers for the early diag-nosis of HBV-related HCC,and combined applications may improve diagnostic efficacy.HSP-90α is not an effective marker for early diagnosis of HBV-HCC.AFP-L3％could be used to distinguish AFP elevation caused by HCC or benign liver diseases.
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