原发性与转移性肝癌患者血清学检测的临床应用*

摘要

Objective:To investigate the clinical value of serological test indicators in the identification of primary and metastatic liver cancers. Methods:We detected the serum levels of ALT, AST, ALP, TBIL, DBIL, GGT, CHE, 5'-NT, CA199, CEA, and AFP in primary hepatic carcinoma (PHC;120 cases), metastatic hepatic carcinoma (MHC;135 cases), and no liver metastatic control (135 cas-es) groups. The methods used were variance analysis and Scheffe test. ROC curve analysis was used to determine the diagnostic value of CA199 , CEA, and AFP in PHC and MHC. Results:The difference between the serum levels of AST, ALP, GGT, 5'-NT, AFP, and CEA of the PHC and MHC groups was statistically significant (P<0.05). The AFP, CEA, and CA199 areas under the ROC curve of the PHC and MHC groups revealed that AFP diagnosis of primary liver cancer had certain accuracy, whereas CEA and CA199 have some diagnostic value in differentiating primary and metastatic liver cancers. Conclusion: The detection of serum levels of AST, GGT, 5'-NT, AFP, CA199, and CEA in malignant tumor was a preliminary diagnosis of liver metastasis and can provide evidence for the dif-ferential diagnosis of PHC and MHC.%　　目的：探讨血清学检测指标在鉴别原发性与转移性肝癌时的临床应用价值。方法：分别测定125例原发性肝癌患者组，135例转移性肝癌患者组及135例无肝转移的癌症患者组血清中ALT、AST、ALP、TBIL、DBIL、GGT、CHE、5'-NT、AFP、CEA、CA199的水平，采用方差析和Scheffe检验进行统计学分析。应用ROC曲线分析AFP、CEA和CA199对原发性肝癌及转移性肝癌的诊断价值。结果：1）原发性肝癌组与转移性肝癌组之间血清AST、ALP、GGT、5'-NT、AFP及CEA水平差异有统计学意义（P<0.05）。2）根据原发性肝癌组和转移性肝癌组AFP、CEA和CA199的ROC曲线下面积（Area under the ROC curve，AUC）判断，AFP对原发性肝癌诊断有一定的准确性，CEA、CA199对鉴别原发性肝癌与转移性肝癌有一定诊断价值。结论：检测血清AST、GGT、5'-NT、AFP、CEA、CA199水平可对恶性肿瘤是否发生肝转移进行初步诊断，亦可对原发性肝癌与转移性肝癌的鉴别诊断提供佐证。