血清PIVKA-Ⅱ在原发性肝癌诊断中的应用

摘要/Abstract

摘要： 目的探究血清PIVKA-Ⅱ对原发性肝癌的诊断价值。方法 2016年2月至11月就诊于徐州医科大学附属医院肝癌患者330例,采用 LUMI - PULSE G1200 全自动免疫分析仪检测患者血清PIVKA-Ⅱ和AFP水平,比较二者在原发性肝癌的诊断和预后监测中的作用。结果血清PIVKA-Ⅱ检测原发性肝癌的敏感度(83.19%)高于血清AFP(66.37%,校正χ²=7.60,P=0.006),且两者联合检测的敏感度(89.38%)也高于血清AFP(校正χ²=16.05,P=0.00);血清PIVKA-Ⅱ与肿瘤体积呈正相关(r=0.63,P=0.00),且随着肿瘤直径增大而检测敏感度提高;血清PIVKA-Ⅱ在肝癌Ⅲ期和Ⅳ期分别高于Ⅰ期和Ⅱ期(Ⅲ期:U=151.00、173.00,P=0.00、0.04;Ⅳ期:U=238.50、292.50,P=0.00、0.02);原发性肝癌患者经手术或介入治疗后,血清PIVKA-Ⅱ下降幅度(80.13%)高于血清AFP(57.87%,χ²=4.226,P=0.04)。结论血清PIVKA-Ⅱ检测原发性肝癌的敏感度和特异度均高于AFP,并且在原发性肝癌的预后亦具有较大意义,可作为临床上检测和评价原发性肝癌预后的肿瘤标志物。

关键词: 原发性肝癌, 异常凝血酶原, 甲胎蛋白

Abstract: Objective To investigate the clinical value of serum prothrombin induced by vitamin K absence-Ⅱ (PIVKA-Ⅱ) in diagnosis of primary liver cancer.Methods Peripheral venous blood serum was collected from 330 patients from February 2016 to November 2016 in our hospital. Serum PIVKA-Ⅱ and alpha-fetoproteins (AFP) levels were measured using LUMI-PULSE G1200 automated immunoassay analyzer, and further analyzed for evaluating their clinical value in diagnosing and monitoring primary liver cancer.Results Serum levels of both PIVKA-Ⅱ and AFP in primary liver cancer group were higher than those in chronic hepatitis group and liver cirrhosis group (PIVKA-Ⅱ:U=1016, 280.5, 582.5, P=0.00, 0.00, 0.00; AFP:U=3534, 1225, 2849,P=0.00, 0.00, 0.00). The sensitivity of serum PIVKA-Ⅱ (83.19%) and combination of PIVKA-Ⅱ and AFP (89.38%) was higher than serum AFP (66.37%, adjusted χ²=7.60, P=0.006, χ²=16.05, P=0.00) in diagnosing primary liver cancer, respectively. The serum level of PIVKA-Ⅱ was positively correlated with tumor volume (r=0.63, P=0.00), and the sensitivity of detection was positively correlated with tumor size. The serum level of PIVKA-Ⅱ was higher in stage Ⅲ and IV than that in stage I and Ⅱ, respectively (Ⅲ: U=151.00, 173.00, P= 0.00, 0.04; IV: U=238.50, 292.50, P=0.00, 0.02). The serum levels of PIVKA-Ⅱ and AFP had no significant correlation with tumor differentiation. The serum levels of PIVKA-Ⅱ and AFP were significantly increased in early primary liver cancer with portal vein thrombosis, intrahepatic metastasis and lymph node enlargement (U=134.00,183.00, P=0.00, 0.01). The levels of serum PIVKA-Ⅱ and AFP were significantly decreased in patients with primary liver cancer after operation or intervention therapy (Z= -5.08,-4.28, P=0.00, 0.00), and the level of serum PIVKA-Ⅱ (80.13%) decreased more than the level of AFP (57.87%, χ²=4.226, P=0.04).Conclusion PIVKA-Ⅱ detection had a higher sensitivity and specificity for diagnosing primary liver cancer than AFP, which could be used as a tumor marker for clinical detection and prediction of primary liver cancer prognosis.

Key words: Primary liver cancer, PIVKA-Ⅱ, AFP

秦亚楠,洪雷,宋正霞,丁芹. 血清PIVKA-Ⅱ在原发性肝癌诊断中的应用[J]. 肝脏, 2017, 22(12): 1103-1106.

QIN Ya-nan, HONG Lei, SONG Zheng-xia, DING Qin. Clinical application of serum PIVKA-Ⅱ in diagnosis of primary liver cancer[J]. Chinese Hepatolgy, 2017, 22(12): 1103-1106.

参考文献

[1] 张建华,马玉梅,闫波.3种指标联合检测诊断原发性肝癌的分析.国际检验医学杂志,2017,38:92-93.
[2] Jia X,Liu J,Gao Y,et al. Diagnosis accuracy of serum glypican-3 in patients with hepatocellular carcinoma: a systematic review with meta-analysis.Archives of Medical Research. Arch Med Res,2014,45:580-588.
[3] Huang S,Jiang F,Wang Y,et al. Diagnostic performance of tumor markers AFP and PIVKA-Ⅱ in Chinese hepatocellular carcinoma patients. Tumour Biol,2017,39:1010428317705763.
[4] 金超超,舒心,黎功.血清PIVKA-Ⅱ在肝细胞肝癌中的应用进展.肝癌电子杂志,2014,3:46-51.
[5] 席强,孙桂荣,丛培珊,等.血清异常凝血酶原和甲胎蛋白联合检测对原发性肝癌的临床价值.中华检验医学杂志,2014,37:928-932.
[6] 中华人民共和国卫生部(卫办医政发[2011]121号).原发性肝癌诊疗规范(2011年版).临床肿瘤学杂志,2011,16:929-946.
[7] Wang Y,Yang H,Xu H,et al. Golgi protein 73, not Glypican-3, may be a tumor marker complementary to α-Fetoprotein for hepatocellular carcinoma diagnosis. J Gastroenterol Hepatol,2014,29: 597-602.
[8] 陈妙研,应志强,陈佳敏,等.血清DCP、GPC3和HSP70检测对AFP阴性PLC的诊断价值.实用肿瘤杂志,2017,32:133-136.
[9] 朱波,肖亚雄,彭宇生,等.GPC3和AFP联合检测在原发性肝癌诊断中的价值.中国肝脏病杂志(电子版),2016,8:110-112.
[10] 袁平戈.瞬时弹性成像技术在肝癌预测、诊断中的应用.泸州医学院学报,2016,39:421-424.
[11] Liebman HA,Furie BC,Tong MJ,et al. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med Overseas Ed,1984,310:1427-31.
[12] Inagaki Y,Tang W,Makuuchi M,et al. Clinical and molecular insights into the hepatocellular carcinoma tumour marker des-γ-carboxyprothrombin. Liver Int,2011,31:22-35.
[13] 吴瑞宗,史春明,王艳.慢性肝病患者凝血功能检测结果分析.中国肝脏病杂志(电子版),2015,7:102-104.
[14] 胡明芬,庄林,李云丽,等.异常凝血酶原对原发性肝癌的诊断价值.中国肝脏病杂志:电子版,2017,1:79-82.
[15] Zakhary NI, Khodeer SM, Shafik HE, et al. Impact of PIVKA-Ⅱ in diagnosis of hepatocellular carcinoma. J Adv Res, 2013, 4:539-546.
[16] 吴飞翔,杨琦,黄盛鑫.检测肝癌微转移的研究新进展.中国肿瘤临床,2013,40:116-118.
[17] Yamashita Y,Tsuijita E,Takeishi K,et al. Predictors for microinvasion of small hepatocellular carcinoma≤2 cm. Ann Surg Oncol,2012,19:2027-2034.
[18] Yu R,Xiang X,Tan Z,et al. Efficacy of PIVKA-Ⅱ in prediction and early detection of hepatocellular carcinoma: a nested case-control study in Chinese patients. J Archaeol Sci Rep,2016,6:35050.