降低AFP诊断阈值并联合检测DCP显著提高肝细胞癌的诊断率

肝脏 ›› 2019, Vol. 24 ›› Issue (5): 507-509.

降低AFP诊断阈值并联合检测DCP显著提高肝细胞癌的诊断率

周宇辰, 袁国盛, 胡承光, 刘俊维, 任彦瑜, 唐淬蓉, 于乐成, 杨定华

510515 广州南方医科大学南方医院肝胆外科(周宇辰,杨定华),感染内科(袁国盛,胡承光,刘俊维,任彦瑜,唐淬蓉);南方医科大学中西医结合医院外科(周宇辰);东部战区总医院,南京中医药大学附属八一医院,全军肝病中心(于乐成)

收稿日期:2019-05-03 发布日期:2020-04-10
通讯作者: 杨定华,Email: 13600039623@163.com;于乐成,Email: gslsycy@163.com
基金资助:
国家自然科学基金(81872385,81772923)

The diagnostic value of combined determining of serum AFP and DCP on early detection of HCC

ZHOU Yu-chen^1,3, YUAN Guo-sheng², HU Cheng-guang², LIU Jun-wei², REN Yan-yu², TANG Cui-rong², YU Yue-cheng⁴, YANG Ding-hua¹

1.Department of Hepatobiliary Surgery;
2.Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China;
3.Department of Surgery, TCM-Integrated Hospital, Southern Medical University, Guangzhou, 510315, China;
4.Liver Diseases Center, General Hospital of Eastern Theater Command, and Bayi Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210002, China

Received:2019-05-03 Published:2020-04-10
Contact: YANG Ding-hua, Email: 13600039623@163.com, YU Yue-cheng, Email: gslsycy@163.com

摘要/Abstract

摘要： 目的评价甲胎蛋白(AFP) 和脱-γ-羧基凝血酶原(DCP) 联合检测对肝细胞癌(HCC)的诊断效能。方法选取临床诊断为HCC的患者75例和非HCC患者53例为研究对象,同时检测血清AFP和DCP浓度,分别绘制AFP、DCP和二者联合检测时的ROC曲线,计算最佳诊断阈值并评价其诊断效能。结果 AFP及DCP诊断HCC的ROC曲线下面积分别为0.789和0.882;当AFP诊断阈值降为22.6 ng/mL时,诊断效能最佳(灵敏度为66.7%、特异性为88.7%);DCP诊断HCC的最适阈值为39.0 mAU/mL,灵敏度为72.0%、特异性为94.3%;二者联合检测诊断HCC的灵敏度为77.3%、特异性为90.6%。结论 DCP对于HCC的鉴别诊断具有重要价值,降低AFP诊断阈值并联合DCP检测可显著提高对HCC的诊断率。

关键词: 肝细胞癌, 甲胎蛋白, 脱-γ-羧基凝血酶原, 灵敏度, 特异性

Abstract: Objective To evaluate the sensitivity and specificity of combined detection of alpha-fetoprotein (AFP) and decarboxylprothrombin (DCP) for the diagnosis of hepatocellular carcinoma (HCC).Methods 75 patients with HCC and 53 patients without HCC were selected as study subjects. Serum AFP and DCP levels were measured simultaneously. The receiver operating characteristic curves (ROC) curves of AFP, DCP and their combined detection were plotted to calculate and evaluate the best serological markers for the diagnosis of HCC.Results The area under the ROC curve for AFP and DCP diagnosis of HCC was 0.789 and 0.882, respectively. When the diagnostic threshold of AFP was reduced to 22.6 ng/mL, the corresponding diagnostic efficiency was the best (sensitivity was 66.7%, specificity was 88.7%); The optimum critical value of DCP for the diagnosis of HCC was 39.0 mAu/ml, the corresponding sensitivity was 72.0% and the specificity was 94.3%. The sensitivity and specificity of combined detection of AFP and DCP for the diagnosis of HCC were 77.3% and 90.6% respectively.Conclusion DCP has important value for the differential diagnosis of HCC. Lowering the AFP diagnostic threshold accompanied with DCP detection can improve the identification rate of HCC.

Key words: Hepatocellular carcinoma, Alpha-fetoprotein, Des-gamma-carboxyprothrombin, Sensitivity, Specificity

周宇辰, 袁国盛, 胡承光, 刘俊维, 任彦瑜, 唐淬蓉, 于乐成, 杨定华. 降低AFP诊断阈值并联合检测DCP显著提高肝细胞癌的诊断率[J]. 肝脏, 2019, 24(5): 507-509.

ZHOU Yu-chen, YUAN Guo-sheng, HU Cheng-guang, LIU Jun-wei, REN Yan-yu, TANG Cui-rong, YU Yue-cheng, YANG Ding-hua. The diagnostic value of combined determining of serum AFP and DCP on early detection of HCC[J]. Chinese Hepatolgy, 2019, 24(5): 507-509.

参考文献

[1] Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016,66:115-132.
[2] European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol, 2018,69:182-236.
[3] Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology, 2018,67:358-380.
[4] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版). 中华肝脏病杂志, 2017,25:886-895.
[5] Chen QW, Cheng CS, Chen H, et al. Effectiveness and complications of ultrasound guided fine needle aspiration for primary liver cancer in a Chinese population with serum alpha-fetoprotein levels ≤200 ng/ml--a study based on 4,312 patients. PLoS One, 2014,9:e101536.
[6] 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, 1984,310:1427-1431.
[7] 杨秉辉, 夏景林, 黄力文, 等. 我国肝癌“临床相”30年的变迁—原发性肝癌3250例的对比研究. 中华医学杂志, 2003,83:49-53.
[8] Zhang XP, Wang K, Cheng SQ. Surveillance for early-stage hepatocellular carcinoma by ultrasound plus alpha-fetoprotein measurement: more details, more significance. Gastroenter-ology, 2018,155:1274-1275.
[9] Luo P, Yin P, Hua R, et al. A Large-scale, multicenter serum metabolite biomarker identification study for the early detection of hepatocellular carcinoma. Hepatology, 2017.
[10] Mazzaferro V, Droz DBM, Bhoori S. Alpha-Fetoprotein (AFP) in liver transplantation for HCC: The lower, the better. Hepatology, 2018.
[11] 田州, 张建淮. 甲胎蛋白诊断和筛查原发性肝癌的阈值分析. 临床肝胆病杂志, 2018,34:2352-2355.
[12] 丁国华, 顾猛. 肝癌实验室诊断指标的选择及最佳阈值探讨. 检验医学与临床, 2009,6:1515-1516.
[13] 李冰, 郭珊, 曹献芹. 异常凝血酶原和甲胎蛋白在原发性肝癌诊断和疗效监测中的应用. 中国实用医刊, 2018,45:32-35.
[14] Ette A I, Ndububa DA, Adekanle O, et al. Diagnostic utility of alpha-fetoprotein and des-gamma-carboxyprothrombin in nigeri-ans with hepatocellular carcinoma. Niger J Clin Pract, 2017,20:1267-1272.
[15] Caviglia GP, Abate ML, Petrini E, et al. Highly sensitive alpha-fetoprotein, Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein and des-gamma-carboxyprothrombin for hepa-tocellular carcinoma detection. Hepatol Res, 2016,46:E130-E135.