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目的:由于维生素K缺乏或拮抗产生的异常蛋白(PIVKAⅡ),又称为γ-羧基凝血素,是近年来在日本及美国诊断肝细胞癌(HCC)的敏感指标,但至今仍未用于中国临床。本研究的目的是评价PIVKAⅡ在中国肝癌患者诊断中的意义。方法:检测60例HCC和30例排除肝癌的肝硬化患者血清中PIVKAⅡ和甲胎球蛋白(AFP)水平。结果:在HCC患者中,血清PIVKAⅡ的浓度为784.3±1364.1,显著高于肝硬化患者的16.1±31.7(P<0.001)。当将PIVKAⅡ的临界值定为40mAU/ml时,51.7％肝癌患者(31/60)的PIVKAⅡ值高于该临界值(灵敏度);但仅13.3％肝硬化患者PIVKAⅡ值高于此临界值。该指标的特异性为86.7％(26/30);精确度为62.2％(31+26/60+30);其中36.84％的小HCC患者(7/19)的PIVKAⅡ值高于此临界值。在26例AFP阴性的肝癌患者中,有11例(46.2%)PIVKAⅡ值高于该临界值;肝癌患者的AFP和PIVKAⅡ水平未见显著相关(r=0.101,P=0.247)。PIVKAⅡ和AFP联合使用较AFP单独使用灵敏度升高21.6％,较PIVKAⅡ单独使用灵敏度升高26.7%;对小肝癌患者,则分别升高15.8％和21.1％。结论:PIVKAⅡ是对肝癌诊断的敏感指标,如果与AFP结合使用,其敏感性更高。
OBJECTIVE: PIVKA II, also known as γ-CCL, as a sensitive marker of hepatocellular carcinoma (HCC) in Japan and the United States in recent years has not been used in China until now clinical. The purpose of this study was to evaluate the significance of PIVKAⅡ in the diagnosis of HCC in China. Methods: The levels of PIVKAⅡ and AFP in 60 patients with HCC and 30 patients with cirrhosis who were excluded from liver cancer were detected. Results: In HCC patients, serum PIVKAII concentration was 784.3 ± 1364.1, significantly higher than that of cirrhosis patients (16.1 ± 31.7, P <0.001). When PIVKA II was set at 40 mAU / ml, 51.7% of hepatocellular carcinomas (31/60) had PIVKA values above this threshold (sensitivity); however, PIVKA II values were higher in 13.3% of cirrhotic patients than this cutoff. The specificity of this indicator was 86.7% (26/30); the accuracy was 62.2% (31 + 26/60 + 30); PIVKA II was higher in 36.84% of small HCC patients (7/19) than this threshold. Eleven patients (46.2%) had PIVKAⅡ values higher than the threshold in 26 AFP-negative patients with liver cancer. There was no significant correlation between AFP and PIVKAⅡlevels in patients with hepatocellular carcinoma (r = 0.101, P = 0.247). The combined use of PIVKAⅡand AFP was 21.6% higher than that of AFP alone, 26.7% higher than that of PIVKAⅡ alone, and 15.8% and 21.1% of those with small hepatocellular carcinoma respectively. Conclusion: PIVKAⅡis a sensitive indicator of the diagnosis of liver cancer, and its sensitivity is higher if it is used in combination with AFP.