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目的探讨高尔基体糖蛋白73(GP73)、α-L-岩藻糖苷酶(AFU)、甲胎蛋白(AFP)单项检测与联合检测对原发性肝癌的诊断价值。方法选择2011年5—9月初次就诊于我院的原发性肝癌患者80例为肝癌组,肝硬化患者65例为肝硬化组,慢性病毒性肝炎患者54例为肝炎组,同期健康体检正常者50例为对照组。采用酶联免疫定量法测定受检者血清GP73水平,免疫比浊法测定血清AFU水平,电化学发光法测定血清AFP水平。计算GP73、AFU、AFP单项检测与联合诊断原发性肝癌的受试者工作特征曲线下面积(AUC)、敏感度、特异度等。结果 4组受检者血清GP73、AFU、AFP水平比较,差异均有统计学意义(P<0.001)。GP73、AFU、AFP单项检测诊断原发性肝癌的AUC为0.804〔95%CI(0.746,0.862)〕、0.798〔95%CI(0.739,0.858)〕和0.797〔95%CI(0.731,0.862)〕,GP73、AFU诊断原发性肝癌的AUC与AFP比较,差异均无统计学意义(P>0.05)。GP73单项检测诊断原发性肝癌的敏感度(82.5%)、特异度(63.3%)与AFP(66.3%、88.7%)比较,差异均有统计学意义(χ2灵敏度=4.65,χ2特异度=28.91,P<0.05);AFU单项检测诊断原发性肝癌的敏感度(73.8%)与AFP比较,差异无统计学意义(χ2=0.89,P>0.05),特异度(77.5%)与AFP比较,差异有统计学意义(χ2=8.40,P<0.05)。联合检测中,GP73+AFU诊断原发性肝癌的敏感度为92.5%,GP73+AFU+AFP的敏感度为96.3%。结论 GP73对诊断原发性肝癌具有较好的敏感度,而AFP具有较好的特异度;GP73、AFU、AFP联合检测有利于提高原发性肝癌诊断率,减少漏诊。
Objective To investigate the diagnostic value of single detection and combined detection of GP73, α-L-fucosidase (AFU) and alpha fetoprotein (AFP) in primary hepatocellular carcinoma (HCC). Methods 80 cases of primary hepatocellular carcinoma (HCC) treated in our hospital from May to September 2011 for the first time were selected as liver cancer group, 65 cases of liver cirrhosis as cirrhosis group, 54 cases of chronic viral hepatitis as hepatitis group and normal physical examination in the same period 50 cases as control group. Serum GP73 levels were measured by enzyme-linked immunosorbent assay (ELISA), serum AFU levels were measured by immunoturbidimetry and serum AFP levels by electrochemiluminescence. Calculate the area under the curve (AUC), sensitivity, specificity and so on of subjects with GP73, AFU, AFP single detection and combined diagnosis of primary liver cancer. Results The serum levels of GP73, AFU and AFP in the four groups were significantly different (P <0.001). The AUC of GP73, AFU and AFP were 0.804 〔95% CI (0.746,0.862)〕, 0.798 〔95% CI (0.739,0.858〕〕 and 0.797 〔95% CI (0.731,0.862〕〕 , GP73, AFU diagnosis of primary liver cancer AUC and AFP, the difference was not statistically significant (P> 0.05). Sensitivity (82.5%), specificity (63.3%) of GP73 single detection in diagnosing primary liver cancer were significantly different from those in AFP (66.3%, 88.7%) (χ2 sensitivity = 4.65, χ2 = 28.91 , P <0.05). There was no significant difference between the two groups (χ2 = 0.89, P> 0.05) and the specificity (77.5%) with AFP in the detection of primary liver cancer by single AFU test (73.8% The difference was statistically significant (χ2 = 8.40, P <0.05). In the combined detection, the sensitivity of GP73 + AFU for diagnosis of primary liver cancer was 92.5% and the sensitivity of GP73 + AFU + AFP was 96.3%. Conclusion GP73 has good sensitivity in the diagnosis of primary liver cancer, while AFP has good specificity. Combined detection of GP73, AFU and AFP is helpful to improve the diagnosis rate of primary liver cancer and reduce missed diagnosis.