血清PIVKA-Ⅱ和AFP联合检测对原发性肝癌的诊疗价值

发布时间：2018-03-09 14:32

  本文选题：PIVKA-II　切入点：癌　出处：《青岛大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:研究与探讨血清异常凝血酶原(PIVKA-II)和甲胎蛋白(AFP)在原发性肝癌(HCC)中的诊断和疗效监测中的临床应用价值。方法:病例对照研究。用化学发光法和电化学发光法检测2013年8月至2014年3月期间青岛大学附属医院148例肝细胞癌、37例肝内胆管细胞癌、44例胃、结直肠癌、63例肝硬化、38例慢性乙型肝炎、57例体检健康者血清PIVKA-II和AFP水平,分别分析两者单独及联合检测诊断HCC的受试者工作曲线下面积(ROC-AUC)、敏感度和特异性;分析血清PIVKA-II和AFP水平与肿瘤直径大小及TNM分期的相关性;比较HCC患者治疗前后两指标血清水平的变化。结果:肝细胞癌组血清PIVKA-II和AFP水平均高于肝内胆管细胞癌组、胃结直肠癌组、肝硬化组、慢性乙型肝炎组和健康对照组(PIVKA-II:U值分别为866.50、424.00、958.00、292.00和448.00;AFP:U值分别为713.00、440.50、1182.00、614.00和399.00,P均0.001)。两指标单独检测和联合检测对HCC组患者的ROC-AUC均无显著性差异(P0.05)。PIVKA-II诊断HCC的敏感度(87.16%)高于AFP(68.92%,χ2=4.73,P0.05),PIVKA-II和AFP联合检测诊断HCC的敏感度(93.24%)高于PIVKA-II单项检测(87.16%,校正χ2=64.70,P0.01),但特异度之间比较均无统计学差异(P0.05)。Spearman秩相关分析显示,血清PIVKA-II和AFP水平与肿瘤大小均呈正相关(相关系数分别为0.716和0.475,P均0.001)。随肿瘤直径增大,HCC患者PIVKA-II和AFP水平逐渐升高(H值分别为72.70、37.02,P均0.001);阳性率也逐渐提高(χ2值分别为26.74、21.62,P均0.01)。按国际肿瘤TNM分期,Ⅰ~Ⅳ期血清PIVKA-II和AFP水平(H值分别为46.63、21.38,P均0.001)与阳性率(PIVKA-II:χ2=20.40,P0.01;AFP:χ2=8.33,P0.05)也随TNM肿瘤分期的增高而升高。HCC患者治疗后血清PIVKA-II和AFP水平均低于治疗前(Z值分别为-4.59、-4.22,P均0.001),不同TNM分期患者治疗后PIVKA-II(Z值分别为-2.85、-2.98、-2.70,P均0.05)和AFP水平均分别低于同期治疗前水平(Z值分别为-2.48、-3.82、-2.50,P均0.05)。结论:血清PIVKA-II和AFP在HCC诊断和疗效监测等方面均具有较高的临床应用价值,用于诊断HCC时,PIVKA-II的敏感度明显高于AFP,两指标联合检测可提高单独检测的敏感度,且不降低其诊断特异度。
[Abstract]:Objective: to study and evaluate the clinical value of serum prothrombin prothrombin (PIVKA-II) and alpha-fetoprotein (AFP) in the diagnosis and efficacy monitoring of primary hepatocellular carcinoma (HCC). Methods: a case-control study. Chemiluminescence and electrochemiluminescence were used. Methods from August 2013 to March 2014, 148 patients with hepatocellular carcinoma (HCC) and 44 patients with intrahepatic cholangiocarcinoma were examined in Qingdao University affiliated Hospital. The serum levels of PIVKA-II and AFP in 38 patients with chronic hepatitis B and 57 healthy controls were analyzed in 63 patients with colorectal cancer and 38 patients with chronic hepatitis B. The sensitivity and specificity of the two methods under the operating curve for the diagnosis of HCC were analyzed. The relationship between serum PIVKA-II and AFP levels and tumor diameter and TNM staging was analyzed, and the changes of serum PIVKA-II and AFP levels in patients with HCC before and after treatment were compared. Results: the levels of serum PIVKA-II and AFP in HCC group were higher than those in intrahepatic cholangiocarcinoma group. Gastric colorectal cancer group, liver cirrhosis group, The values of PIVKA-IIU in chronic hepatitis B group and healthy control group were 866.50 ~ 424.00 ~ 958.00 ~ 292.00 and 448.00 ~ 48.00 ~ 292.00 and 448.00 = 713.00 ~ 440.50 ~ 1182.00 ~ 614.00 and 399.00% respectively respectively. There was no significant difference between the two indexes in the diagnosis of ROC-AUC in HCC group (P 0.05). PIVKA-II was 87.16) higher than AFP 68.92%, 24.73% P 0.05% PIVKA-II and AFP (蠂 ~ 2 蠂 ~ (2)) were higher than that in AFP group (P = 68.92), respectively. There was no significant difference between the two indexes in the diagnosis of HCC by P0.05. PIVKA-II) and the sensitivity of PIVKA-II was 87.16% higher than that of AFP 68.92%. The sensitivity of the combined detection in the diagnosis of HCC was higher than that in the single test of PIVKA-II (87.16). The correction of 蠂 2 + 64.70% P0.01D was significant, but there was no significant difference in the specificity between the two groups (P 0.05N. Spearman rank correlation analysis). The serum levels of PIVKA-II and AFP were positively correlated with tumor size (correlation coefficients were 0.716 and 0.475g / kg, respectively). With the increase of tumor diameter, PIVKA-II and AFP levels increased gradually, and the H values were 72.70 and 37.02, respectively, and the positive rates were also gradually increased (蠂 2 were respectively). 26.74-21.62P and 0.01g / L respectively. According to the international TNM stage of tumor, Serum PIVKA-II and AFP levels in stage 鈪，

本文编号：1588936