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目的探讨血清高尔基体蛋白73(GP73)和甲胎蛋白(AFP)检测在HBsAg阳性原发性肝癌诊断及联合诊断中的价值。方法采用ELISA法和微粒子酶免疫分析技术对29例慢性乙型肝炎、28例乙肝肝硬化、55例原发性肝癌(以下简称肝癌)患者及22例健康体检者的血清GP73和AFP进行检测。结果 HBsAg阳性肝癌患者血清GP73和AFP水平均显著高于其他组(P均<0.05),两指标的阳性率(79.91%和40.00%)均显著高于其他疾病组(AFP对乙肝肝硬化时除外)及正常对照组(P均<0.01)。血清GP73单项检测诊断HBsAg阳性肝癌的灵敏度、特异性和准确性均高于血清AFP(70.91%vs 40.00%,P<0.01;92.41%vs88.61%,P>0.05;83.58%vs 68.66%,P<0.01);GP73与AFP联合检测(平行试验)的灵敏度与GP73单项检测时相同,特异性和准确性均降低(86.08%vs 92.41%,79.85%vs 83.58%),差异无统计学意义(P>0.05);GP73与AFP联合检测(系列试验)提高了特异性(94.94%vs 92.41%),但差异均无统计学意义(P>0.05),而且还显著降低了灵敏度(40.00%vs 70.91%)和准确性(72.39%vs 83.58%)(P均<0.05)。结论血清GP73对HBsAg阳性原发性肝癌的诊断价值优于AFP,两者联合检测不能提高诊断效率。
Objective To investigate the value of serum GP73 and AFP in the diagnosis and combined diagnosis of HBsAg positive primary liver cancer. Methods Serum GP73 and AFP in 29 patients with chronic hepatitis B, 28 patients with hepatitis B cirrhosis, 55 patients with primary hepatocellular carcinoma (HCC) and 22 healthy controls were detected by ELISA and microparticle enzyme immunoassay. Results The serum levels of GP73 and AFP in patients with HBsAg positive hepatocellular carcinoma were significantly higher than those in other groups (all P <0.05). The positive rates of both markers were significantly higher than those in other disease groups (79.91% and 40.00%, respectively) ) And normal control group (all P <0.01). The sensitivity, specificity and accuracy of serum GP73 single detection in diagnosing HBsAg positive hepatocellular carcinoma were all higher than those in serum AFP (70.91% vs 40.00%, P <0.01; 92.41% vs88.61%, P> 0.05; 83.58% vs68.66%, P <0.01). The sensitivity of GP73 and AFP combined test (parallel test) was the same as that of GP73 single test, the specificity and accuracy were lower (86.08% vs 92.41%, 79.85% vs 83.58%), with no significant difference > 0.05). The combined detection of GP73 and AFP increased the specificity (94.94% vs 92.41%), but the difference was not statistically significant (P> 0.05), but also significantly reduced the sensitivity (40.00% vs 70.91% ) And accuracy (72.39% vs 83.58%) (all P <0.05). Conclusion The diagnostic value of serum GP73 is better than that of AFP in HBsAg positive primary liver cancer. The combination of the two can not improve the diagnostic efficiency.