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目的探讨血清肿瘤标志物甲胎蛋白异质体(AFP-L3)和高尔基体蛋白73(GP73)单独和联合检测在原发性肝癌(PHC)诊断中的临床意义。方法采用酶联免疫吸附测定法(ELISA)进行检测180例患者(80例PHC患者、50例肝硬化患者和50例健康体检者)血清中AFP-L3和GP73的浓度,并比较各组水平差异,运用受试者工作曲线(recover operation characteristic,ROC)确定AFP-L3和GP73浓度诊断PHC的最佳临界值,分析评价AFP-L3和GP73单独检测及2种方法联合检测在PHC中的诊断价值。结果 PHC患者、肝硬化患者、正常对照组的血清AFP-L3浓度分别为(65.234±21.315)ng/ml、(18.614±20.655)ng/ml、(13.209±14.560)ng/ml,PHC组AFPL3水平显著高于肝硬化组及正常组(P<0.001);肝硬化组与正常组的AFP-L3水平比较差异无统计学意义(P=0.134)。通过血清中AFP-L3水平绘制诊断PHC的ROC曲线,AFP-L3诊断PHC的最佳临界值:≥36.076 ng/ml,其诊断敏感性和特异性分别为75.00%、94.00%。PHC组患者、肝硬化组患者、正常对照组的血清GP73浓度分别为(0.431±0.180)IU/ml、(0.228±0.047)IU/ml、(0.213±0.034)IU/ml,PHC组GP73水平明显高于肝硬化组及正常组(P<0.001);而GP73水平在肝硬化组与正常组比较中差异无统计学意义(P=0.069)。通过血清GP73水平绘制诊断PHC的ROC曲线,GP73诊断PHC的最佳临界值:≥0.298 IU/ml,其诊断敏感性和特异性分别为80.00%和96.00%;联合检测AFP-L3和GP7诊断PHC的敏感性为92.50%,特异性为90.00%。结论AFP-L3和GP73是诊断PHC良好的血清肿瘤标志物,均有较高特异性,但敏感度不理想。AFP-L3与GP73联合检测,可提高PHC诊断的敏感性和特异性,对PHC的早期诊断具有积极的意义。
Objective To investigate the clinical significance of serum and tumor marker AFP-L3 and GP73 in the diagnosis of primary hepatocellular carcinoma (PHC). Methods Serum levels of AFP-L3 and GP73 in 180 patients (80 PHC patients, 50 cirrhosis patients and 50 healthy subjects) were detected by enzyme-linked immunosorbent assay (ELISA), and the level differences of each group were compared The receiver operating characteristic curve (ROC) was used to determine the optimal cutoff value of AFP-L3 and GP73 for the diagnosis of PHC. The diagnostic value of the combined detection of AFP-L3 and GP73 and the combined detection of two methods in PHC . Results The serum levels of AFP-L3 in patients with PHC, cirrhosis and normal controls were (65.234 ± 21.315) ng / ml, (13.209 ± 14.560) ng / ml, (P <0.001). There was no significant difference in AFP-L3 levels between the cirrhosis group and the normal group (P = 0.134). The best cut-off value of AFP-L3 for diagnosis of PHC was drawn by AFP-L3 level in serum. The diagnostic sensitivity and specificity of AFP-L3 were 75.00% and 94.00%, respectively. The serum levels of GP73 in PHC group, cirrhosis group and normal control group were (0.431 ± 0.180) IU / ml, (0.228 ± 0.047) IU / ml and (0.213 ± 0.034) (P <0.001). However, there was no significant difference in the level of GP73 between the cirrhosis group and the normal group (P = 0.069). The ROC curve of diagnosis PHC was drawn by serum GP73 level. The best cutoff value of GP73 diagnosis PHC was ≥0.298 IU / ml, the diagnostic sensitivity and specificity were 80.00% and 96.00% respectively. Combined detection of AFP-L3 and GP7 detected PHC The sensitivity was 92.50% and the specificity was 90.00%. Conclusions AFP-L3 and GP73 are good serum tumor markers for the diagnosis of PHC, all of which have high specificity but not good sensitivity. AFP-L3 and GP73 joint detection, can improve the sensitivity and specificity of PHC diagnosis, PHC early diagnosis has a positive meaning.