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