乙型肝炎肝硬化患者血清AFP、AFP-L3和PIVKA-Ⅱ表达水平及其与肝癌的关系

肝脏 ›› 2026, Vol. 31 ›› Issue (7): 962-965.

乙型肝炎肝硬化患者血清AFP、AFP-L3和PIVKA-Ⅱ表达水平及其与肝癌的关系

张娇娇, 韩宁, 薛彩梅

710021 西安西安市中医医院脾胃病科(张娇娇);
710038 西安空军军医大学唐都医院消化内科(韩宁);
719300 榆林神木市医院(西北大学附属神木医院)检验科(薛彩梅)

收稿日期:2026-01-30 出版日期:2026-07-31 发布日期:2026-08-21
通讯作者: 薛彩梅,Email:1532195775@qq.com

The serum AFP, AFP-L3, and PIVKA-Ⅱ levels in patients with hepatitis B-related cirrhosis and their relationship with the occurrence of liver cancer

Zhang Jiaojiao¹, Han Ning², Xue Caimei³

1. Department of Spleen and Stomach Diseases, Xi′an Hospital of Traditional Chinese Medicine, Xi′an 710021, China;
2. Department of Gastroenterology, Tangdu Hospital Air Force Medical University, Xi′an 710038, China;
3. Department of Clinical Laboratory, Shenmu Hospital (Affiliated Hospital of Northwest University), Yulin 719300, China

Received:2026-01-30 Online:2026-07-31 Published:2026-08-21
Contact: Xue Caimei,Email:1532195775@qq.com

摘要/Abstract

摘要： 目的探讨乙型肝炎肝硬化患者血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、异常凝血酶原(PIVKA-Ⅱ)表达水平并分析其与肝癌发生的关系。方法回顾性纳入2015年1月至2019年12月我院收治的245例乙型肝炎肝硬化患者,随访4年,根据随访结局,将患者分为肝癌组(37例)和肝硬化组(208例)。比较两组患者血清AFP、AFP-L3、PIVKA-Ⅱ水平,评估其预测价值;采用多因素logistic回归分析评估危险因素。结果肝癌组血清AFP、AFP-L3、PIVKA-Ⅱ水平分别为(198.65±59.47)ng/mL、(21.86±3.22)%、(385.75±91.63)mAU/mL,显著高于肝硬化组[分别为(25.26±8.37)ng/mL、(7.24±1.95)%、(56.92±15.26)mAU/mL,P<0.05]。血清AFP、AFP-L3、PIVKA-Ⅱ单独及联合预测肝癌发生的曲线下面积分别为0.849、0.866、0.763、0.941,灵敏度分别为0.761、0.789、0.737、0.842,特异度分别为0.779、0.794、0.750、0.868(P<0.05)。Logistic回归分析结果显示,血清AFP、AFP-L3、PIVKA-Ⅱ是肝癌发生的独立危险因素(P<0.05)。结论对于乙型肝炎肝硬化患者,血清AFP、AFP-L3和PIVKA-Ⅱ水平升高可增加肝癌发生风险,监测这3项血清标志物有助于识别肝癌发生的高危人群。

关键词: 乙型肝炎肝硬化, 肝癌, 甲胎蛋白, 甲胎蛋白异质体, 异常凝血酶原

Abstract: Objective This study aimed to investigate the serum levels of alpha-fetoprotein (AFP), alpha-fetoprotein isoform (AFP-L3), and protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) in patients with hepatitis B-related cirrhosis and to analyze their relationship with the occurrence of liver cancer. Methods This retrospective study included 245 patients with hepatitis B-related cirrhosis admitted to our hospital between January 2015 and December 2019. The patients were followed up for 4 years. Based on the follow-up outcomes, they were divided into a liver cancer group (37 cases) and a liver cirrhosis group (208 cases). Compare the levels of serum AFP, AFP-L3 and PIVKA-Ⅱ in the two groups of patients. The predictive performance was evaluated by receiver operating characteristic (ROC) curve analysis, and the independent risk factors were analyzed using multivariate logistic regression. Results The levels of serum AFP, AFP-L3 and PIVKA-Ⅱ in the liver cancer group were (198.65 ± 59.47) ng/mL, (21.86 ± 3.22)% and (385.75 ± 91.63) mAU/mL respectively, which were significantly higher than those in the liver cirrhosis group [(25.26 ± 8.37) ng/mL, (7.24 ± 1.95)% and (56.92 ± 15.26) mAU/mL respectively, P<0.05]. The areas under the curves for predicting the occurrence of liver cancer by serum AFP, AFP-L3, and PIVKA-Ⅱ alone and in combination were 0.849, 0.866, 0.763, and 0.941, respectively; the sensitivities were 0.761, 0.789, 0.737, and 0.842, respectively; and the specificities were 0.779, 0.794, 0.750, and 0.868, respectively (P<0.05). The results of the logistic regression analysis indicated that for patients with hepatitis B-related liver cirrhosis, serum AFP, AFP-L3, and PIVKA-Ⅱ were independent risk factors for the occurrence of liver cancer (P<0.05). Conclusion For patients with hepatitis B-related liver cirrhosis, elevated levels of serum AFP, AFP-L3 and PIVKA-Ⅱ can increase the risk of liver cancer. Monitoring these three serum markers is helpful in identifying high-risk individuals for liver cancer occurrence.

Key words: Hepatitis B cirrhosis, Liver cancer , Alpha-fetoprotein , Alpha-fetoprotein isoform , Protein induced by vitamin K absence or antagonist-Ⅱ

张娇娇, 韩宁, 薛彩梅. 乙型肝炎肝硬化患者血清AFP、AFP-L3和PIVKA-Ⅱ表达水平及其与肝癌的关系[J]. 肝脏, 2026, 31(7): 962-965.

Zhang Jiaojiao, Han Ning, Xue Caimei. The serum AFP, AFP-L3, and PIVKA-Ⅱ levels in patients with hepatitis B-related cirrhosis and their relationship with the occurrence of liver cancer[J]. Chinese Hepatolgy, 2026, 31(7): 962-965.

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