血清AFP-L3、PIVKA-Ⅱ联合检测在慢性乙型肝炎相关肝细胞癌中的诊断价值

摘要/Abstract

摘要： 目的分析联合检测血清甲胎蛋白异质体(AFP-L3)、异常凝血酶原(PIVKA-Ⅱ)诊断慢性乙型肝炎(CHB)相关肝细胞癌(HCC)的价值。方法选取2022年1月—2024年1月期间在沭阳县中医院接受诊治的CHB患者85例,其中男性63例、女性22例,年龄(47.3±7.4)岁。根据是否伴有HCC分为CHB慢性肝病(CHB-CLD)组(包括HCV及其肝硬化)、CHB-HCC组。比较CHB-CLD、CHB-HCC临床资料,并采用多因素logistic回归分析CHB-HCC发生的独立危险因素,绘制ROC曲线分析血清学指标预测CHB-HCC患者的价值。随访CHB-HCC,比较不同临床结局患者AFP、AFP-L3、PIVKA-Ⅱ的差异。结果 85例CHB患者中,CHB及其肝硬化病例为40例、28例,另外17例为CHB-HCC。CHB-HCC组年龄为(54.2±9.7)岁,显著高于CHB-CLD[(45.5±7.7)岁,P<0.05];CHB-HCC组AFP、Alb、ALT、AST、AFP-L3及PIVKA-Ⅱ为516.3(78.4, 1482.5)ng/mL、(31.0±2.1)g/L、80(51, 104)U/L、92(70, 137)U/L、12.8(8.6, 73.0)%及674.6(209.3, 1526.8)mAU/mL,与CHB-CLD[17.2(9.8, 32.8)ng/mL、(36.8±3.7)g/L、47(38, 66)U/L、44(32, 62)U/L、5.2(3.2, 6.7)%及27.2(18.1, 41.2)mAU/mL]比,差异有统计学意义(P<0.05)。将上述差异性指标纳入多因素logistic回归分析,设定纳入的P值为0.05,排除的P值为0.10。结果显示,AFP≥40.5 ng/mL、AFP-L3≥9.4%及PIVKA-Ⅱ≥57.8 mAU/mL对CHB-HCC的影响均具有统计学意义(P<0.05)。在诊断CHB-HCC时,AFP、AFP-L3、PIVKA-Ⅱ三者联合诊断AUC值为0.91,均显著高于AFP、AFP-L3、PIVKA-Ⅱ单独诊断[0.80、0.83、0.84,P<0.05]。随访2年,CHB-HCC组中存活6例、死亡11例。与存活患者比,死亡患者AFP、AFP-L3和PIVKA-Ⅱ显著升高(P<0.05)。结论联合检测AFP、AFP-L3和PIVKA-Ⅱ水平能够有效诊断CHB-HCC,同时对预测患者临床结局也具有一定的临床意义。

关键词: 慢性乙型肝炎, 肝细胞癌, 甲胎蛋白异质体, 异常凝血酶原

Abstract: Objective To alanyze the value of a combined detection of serum AFP-L3 and abnormal prothrombin (PIVKA-Ⅱ) in the diagnosis of chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). Methods Between January 2022 and January 2024, eighty-five patients with CHB in Traditional Chinese Medicine Hospital of Shuyang County were selected, including 63 males and 22 females, aged (47.3±7.4) years. They were divided into CHB-related chronic liver disease (CHB-CLD) group (including those with HCV and related cirrhosis) and CHB-HCC group according to whether they were complicated by HCC or not. The clinical data of CHB-CLD and CHB-HCC patients were compared, and the independent risk factors of CHB-HCC were analyzed by multiple logistic regression. ROC curve was drawn to analyze the value of serological indicators in predicting the prognosis of CHB-HCC patients. The CHB-HCC patients were followed-up and the differences of AFP, AFP-L3 and PIVKA-Ⅱ were compared in patients with different clinical outcomes. Results Among 85 CHB patients ,40 cases had CHB, 28 cases had cirrhosis, and 17 cases had CHB-related HCC. The age of CHB-HCC group was (54.2±9.7) years, which was significantly higher than that of (45.5±7.7) years in CHB-CLD group [P<0.05]. The AFP, Alb, ALT, AST, AFP-L3 and PIVKA-Ⅱ in CHB-HCC group were 516.3 (78.4, 1482.5) ng/mL, (31.0±2.1) g/L, 80 (51, 104) U/L, 92 (70, 104) U/L, 12.8 (8.6, 73.0) % and 674.6 (209.3, 1526.8) mAU/mL, respectively, compared with those of 17.2 (9.8, 32.8) ng/mL, (36.8±3.7) g/L, 47(38, 66) U/L, 44(32, 62) U/L, 5.2(3.2, 6.7) % and 27.2(18.1, 41.2) mAU/mL in CHB-CLD group [ P<0.05]. The above differences were included in multiple logistic regression analysis. The included P value was set at 0.05, and the excluded P value was set at 0.10. The results showed that AFP≥40.5 ng/mL, AFP-L3≥9.4% and PIVKA-Ⅱ ≥ 57.8 mAU/mL had statistically significant effects on CHB-HCC (P<0.05). In the diagnosis of CHB-HCC, the AUC value of the combined AFP, AFP-L3 and PIVKA-Ⅱ diagnosis was 0.91, which were significantly higher than those of AFP, AFP-L3 or PIVKA-Ⅱ alone (0.80, 0.83 and 0.84, respectively, P<0.05). A follow-up of 2 years showed that 6 cases survived and 11 cases died in CHB-HCC group. Compared with the surviving patients, AFP, AFP-L3 and PIVKA-Ⅱ in the dead patients were significantly higher (P<0.05). Conclusion A combined detection of AFP, AFP-L3 and PIVKA-Ⅱ levels can effectively diagnose CHB-HCC, which has certain clinical significance in predicting the patients' clinical outcome.

Key words: Chronic hepatitis B, Hepatocellular carcinoma, Alpha-fetoprotein-L-3, Protein induced by vitamin K antagonist-Ⅱ

李兰亚, 屠涛. 血清AFP-L3、PIVKA-Ⅱ联合检测在慢性乙型肝炎相关肝细胞癌中的诊断价值[J]. 肝脏, 2025, 30(4): 449-452.

LI Lan-ya, TU Tao. The diagnostic value of combined detection of serum AFP-L3 and PIVKA-Ⅱ in patients with chronic hepatitis B-related hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(4): 449-452.

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