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目的:探讨甲胎蛋白异质体(AFP-L3)对AFP低中浓度升高的原发性肝癌(PHC)的临床诊断价值。方法:以AFP介于20~400 ng/m L的284例肝病患者作为研究对象。应用电化学发光免疫分析法检测总AFP和AFP-L3的含量并计算AFP-L3占AFP总量的百分比即AFP-L3比率。结果:PHC患者AFP-L3阳性率显著高于肝硬化、慢性肝炎及急性肝炎患者(均P<0.01)。根据ROC曲线,在AFP低中浓度升高条件下,AFP-L3比率的Youden指数及AUC值均比AFP高。在AFP处于20~200 ng/m L低度升高时AFP-L3比率具有更高的诊断特异度及准确度。结论:在甲胎蛋白浓度低中度升高时,特别是在AFP浓度<200ng/m L条件下,AFP-L3比率对PHC的确诊具有重要的临床意义。
Objective: To investigate the clinical diagnostic value of alpha-fetoprotein (AFP-L3) in primary liver cancer (PHC) with low level of AFP. METHODS: A total of 284 patients with liver disease with AFP between 20 and 400 ng/m L were studied. The content of total AFP and AFP-L3 was measured by electrochemiluminescence immunoassay and the ratio of AFP-L3 to total AFP was calculated as AFP-L3 ratio. Results: The positive rate of AFP-L3 in PHC patients was significantly higher than those in patients with cirrhosis, chronic hepatitis and acute hepatitis (all P<0.01). According to the ROC curve, the Youden index and the AUC value of the AFP-L3 ratio are higher than those of the AFP under the condition that the AFP increases in low and medium concentrations. The AFP-L3 ratio has higher diagnostic specificity and accuracy when AFP is at a low elevation of 20 to 200 ng/mL. Conclusion: When the alpha fetoprotein concentration is low and moderately elevated, especially when the AFP concentration is less than 200 ng/ml, the AFP-L3 ratio has important clinical significance for the diagnosis of PHC.