血清维生素K缺乏诱导蛋白Ⅱ检测对原发性肝癌的诊疗价值
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The value of serum protein induced by vitamin K absence II detection in the diagnosis and treatment of primary hepatocellular carcinoma LI Heng, TU Cong-yin. General Surgeryபைடு நூலகம் Anhui Provincial Cancer Hospital, Hefei 231000, China
Abstract Objective To explore the value of protein induced by vitamin K absence II (PIVKA-II) in the diagnosis and efficacy evaluation of primary hepatocellular carcinoma (PHC). Methods A total of 60 patients with PHC (PHC group) and 60 patients with chronic viral hepatitis B cirrhosis (hepatitis B cirrhosis group) treated in Anhui Provincial Carcer Hospital from Jun. 2014 to Dec. 2017 were selected as study object. Another 60 healthy objects were selected as control group. Indexes of serum PIVKA-II and AFP among the three groups were compared. Sensitivities and specificities of PIVKA-II, AFP, and combination of PIVKA-II and AFP were calculated, respectively. The ROC curves of PIVKA-II and AFP for PHC were drawn. The correlation between serum levels of PIVKA-II, AFP and diameter of tumor, TNM stages were analyzed by Spearman method. Results The serum levels of PIVKA-II and AFP in the PHC group were higher than those in the hepatitis B cirrhosis group and control group (P<0.01). The serum level of AFP in the hepatitis B cirrhosis group was higher than that in the control group (P<0.01). The difference of serum PIVKA-II between the hepatitis B cirrhosis group and control group was not statistically significant (P>0.05). The sensibilities of serum PIVKA-II and AFP for diagnosing PHC were 81.67% and 66.67%, the specificities were 90.00% and 87.50%, respectively. The sensibility of PIVKA-II parallel connection with AFP was 85.00%, the specificity of PIVKA-II series connection
第31卷第7期 2019年7月
肝胆胰外科杂志 Journal of Hepatopancreatobiliary Surgery
Vol.31 No.7 Jul. 2019
·论著 临床研究·
血清维生素K缺乏诱导蛋白II检测对原发性 肝癌的诊疗价值
李恒,涂从银 (安徽省肿瘤医院 综合外科,安徽 合肥 231000)
开放科学标识码 (OSID)
[摘 要] 目的 探讨血清维生素K缺乏诱导蛋白II(PIVKA-II)对原发性肝癌(PHC)患者的诊断和疗效 评估价值。方法 收集安徽省肿瘤医院2014 年6 月至2017 年12 月收治的PHC患者(PHC组)和慢性乙型 病毒性肝炎后肝硬化患者(乙肝肝硬化组)各60 例,同期选取我院60 例健康体检者作为对照组。比较3 组 间血清PIVKA-II和甲胎蛋白(AFP)指标水平。计算PIVKA-II、AFP及PIVKA-II联合AFP诊断PHC的敏感 度、特异度,绘制PIVKA-II、AFP诊断PHC的ROC曲线图。采用Spearman法分析初诊时PHC组患者血清 PIVKA-II、AFP水平与肿瘤直径、TNM分期之间的相关性。比较PHC患者治疗前和治疗后血清PIVKAII、AFP水平。结果 PHC组患者的血清PIVKA-II、AFP水平高于乙肝肝硬化组和健康对照组(P<0.01), 乙肝肝硬化组血清AFP水平高于健康对照组(P<0.01),而乙肝肝硬化组与健康对照组血清PIVKA-II水平 差异无统计学意义(P>0.05)。PIVKA-II、AFP 诊断 PHC 的敏感度分别为 81.67%、66.67%,特异度分别为 90.00%、87.50%;两指标并联敏感度为 85.00%,两指标串联特异度为 94.17%;PIVKA-II、AFP 诊断 PHC 的 ROC 曲线下面积分别为 0.928、0.824。Spearman 秩相关分析显示,PHC 患者血清 PIVKA-II、AFP 水平与肿 瘤直径(r 分别为 0.642、0.513,P<0.05)和 TNM 分期均呈正相关(r 分别为 0.706、0.524,P<0.05)。PHC 患 者行外科和介入治疗后血清PIVKA-II、AFP水平均较治疗前下降(P<0.05)。结论 血清PIVKA-II、AFP单 独检测时,PIVKA-II对PHC的诊断效能高于AFP,两指标联合检测可以提高诊断敏感度和特异度。血清 PIVKA-II、AFP与肿瘤直径、TNM分期呈中等度相关,可作为PHC患者术后疗效的评价指标。 [关键词] 维生素K缺乏诱导蛋白II;原发性肝癌;甲胎蛋白;敏感度;特异度;早期诊断;疗效评估 [中图分类号] R735.7; R446.11 [文献标识码] A doi:10.11952/j.issn.1007-1954.2019.07.007