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目的 探讨血清异常凝血酶原(PIVKA-II)和甲胎蛋白(AFP)在原发性肝癌中的诊断和疗效监测中的临床应用价值.方法 选取2013年12月至2015年10月确诊为原发性肝癌的患者108例作为研究组,以同期肝内胆管细胞癌患者79例、慢性乙型肝炎患者92例、肝硬化患者94例、健康体检者102例作为对照组.分别对受试者进行PIVKA-II和AFP检测,将研究组和各对照组的检测结果进行比较,分析PIVKA-II和AFP检测对诊断原发性肝癌的敏感度和特异度.对原发性肝癌患者进行联合射频消融或根治性手术治疗,比较原发性肝癌患者治疗前后PIVKA-II和AFP水平.结果 研究组PIVKA-II和AFP检测水平分别为(1 562.47±129.13)mAU/ml、(132.49±17.27)ng/ml,显著高于肝内胆管细胞癌组、慢性乙型肝炎组、肝硬化组和健康体检组,差异具有统计学意义(P<0.05);研究组PIVKA-II、AFP阳性率均高于其他各组(P<0.05);PIVKA-II检测和AFP检测诊断原发性肝癌的敏感度分别为84.3%、78.7%,特异度均为98.6%.PIVKA-II、AFP均为阳性检测敏感度为70.4%,特异度为100%;PIVKA-II、AFP任一阳性检测敏感度为92.6%,特异度为97.3%;原发性肝癌患者接受治疗后,PIVKA-II和AFP水平均显著降低,与治疗前比较具有统计学差异(P<0.05).结论 PIVKA-II和AFP检测诊断原发性肝癌敏感度高,特异度高,误诊少,而且通过监测二者在血清中浓度的改变能够反映治疗效果.“,”Objective To investigate the value of testing serum PIVKA-II and AFP level for diagnosing primary hepatic carcinoma and evaluate clinical effect.Methods 108 cases of primary hepatic carcinoma patients were selected as research group.79 cases intrahepatic cholangiocarcinoma patients, 92 cases chronic hepatitis B patients, 94 cases cirrhosis patients and 102 cases healthy people as control group.The serum PIVKA-II and AFP level of all the people selected were tested.And the PIVKA-II and AFP result were compared.Primary hepatic carcinoma patients were treated by radiofrequency ablation or radical operation.The PIVKA-II and AFP level before and after treatment were compared.Results The PIVKA-II and AFP level of primary hepatic carcinoma patients were (1 562.47±129.13) mAU/ml, (132.49±17.27) ng/ml, those were significantly higher than those in intrahepatic cholangiocarcinoma group, chronic hepatitis B group, cirrhosis group and healthy group (P<0.05).The PIVKA-II positive rate and AFP positive rate of research group were higher than those of other groups (P<0.05).The sensitivity of PIVKA-II and AFP testing for diagnosing primary hepatic carcinoma were 84.3%, 78.7%, and the specificity were 98.6% both.The sensitivity of PIVKA-II combined with AFP testing for diagnosing primary hepatic carcinoma was 78.7%, and the specificity was 100%.After treatment, the PIVKA-II and AFP level were lower than that before treatment (P<0.05).Conclusion PIVKA-II and AFP testing has high sensitivity and specificity for diagnosing primary hepatic carcinoma.They can play an important role in evaluating the clinical effect for primary hepatic carcinoma treatment.