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目的探讨血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)及高尔基体糖蛋白73(GP73)检测诊断原发性肝癌(PHC)的价值。方法采用电化学发光法分别检测100例PHC患者(肝癌组)、55例肝硬化患者(肝硬化组)和95例健康体检者(健康对照组)AFP,阳性者(≥20μg/L)采用微量离心柱法检测AFP-L3,并采用酶联免疫法检测GP73。结果 AFP、AFP-L3和GP73在肝癌组的检测值均高于肝硬化组、健康对照组(P<0.05);AFP单项诊断PHC的曲线下面积(AUG)为0.902,灵敏度67.0%,特异性90.7%,准确度81.2%;AFP-L3单项诊断的AUG为0.970,灵敏度37.0%,特异性100.0%,准确度74.8%;GP73单项诊断AUG为0.923,灵敏度56.0%,特异性98.0%,准确度81.2%;三者联合检测对PHC诊断的灵敏度提高为78.0%,特异性为90.0%,准确度为85.2%;单项与联合检测比较,差异有统计学意义(P均<0.05)。结论单项检测诊断PHC AFP-L3(%)优于GP73和AFP,三项联合检测可显著提高PHC的诊断敏感度和正确性。
Objective To investigate the value of serum AFP, AFP-L3 and GP73 in diagnosis of primary hepatocellular carcinoma (PHC). Methods AFP was detected in 100 patients with PHC, 55 patients with cirrhosis (cirrhosis) and 95 healthy controls (healthy control group) by electrochemiluminescence. The positive patients (≥20 μg / L) AFP-L3 was detected by centrifugation and GP73 was detected by enzyme-linked immunosorbent assay. Results The detection values of AFP, AFP-L3 and GP73 in hepatocellular carcinoma were higher than those in cirrhosis and healthy controls (P <0.05). The AUC of single diagnosis of AFP was 0.902 with a sensitivity of 67.0% 90.7%, and accuracy of 81.2%. The AUG of single diagnosis of AFP-L3 was 0.970, the sensitivity was 37.0%, the specificity was 100.0% and the accuracy was 74.8%. The AUG of single diagnosis of GP73 was 0.923, the sensitivity was 56.0%, the specificity was 98.0% 81.2% respectively. The sensitivities of the three tests for combined diagnosis of PHC were 78.0%, specificity was 90.0% and accuracy was 85.2%. There was significant difference between single and combined tests (P <0.05). Conclusion The single detection of PHC AFP-L3 (%) is superior to GP73 and AFP. The three combined detection can significantly improve the diagnostic sensitivity and correctness of PHC.