肝细胞癌血清肿瘤标志物DCP、AFP-L3和AFP的表达及临床意义

摘要

目的:分析肝细胞癌(HCC)的3种肿瘤标志物脱-γ-异常凝血酶原(DCP)、甲胎蛋白异质体(AFP-L3)和甲胎蛋白(AFP)单独或联合检测,诊断HCC的临床意义.方法:分别用酶联免疫吸附试验检测HCC组、肝硬化组和慢性乙型肝炎(慢乙肝)组患者血清DCP、AFP-L3%和AFP水平,并比较3组患者肿瘤标志物水平的差异;利用诊断试验评价分析3种肿瘤标志物单独或联合检测诊断HCC的敏感性、特异性、曲线下面积及Youden指数.结果:HCC组患者血清DCP、AFP-L3%和AFP水平均高于肝硬化和慢乙肝组患者(P<0.01).在40 mAU/ml的临界值下,DCP诊断HCC的敏感性和特异性为87.88%和95.00%;在10%的临界值下,AFP-L3%诊断HCC的敏感性和特异性分别为57.58%和90.00%;在20 ng/ml的临界值下,AFP诊断HCC的敏感性和特异性分别为75.76%和63.33%;2种或3种标志物联合检测诊断HCC的敏感性和特异性均未高于DCP单独检测.结论:无论是DCP、AFP-L3%和AFP单独检测还是联合检测,DCP均具有最好的敏感性和特异性,或许可以作为发现HCC的主要血清标志物.%Objective: To analyze the clinical significance of detection of des-γ-carboxyprohrombin ( DCP) , α-fetoprotein-L3 ( AFP-L3% ) and α-fetoprotein(AFP) alone or in combination for diagnosis of hepatocellular carcinoma( HCC). Methods: The serum levels of those three biomarkers were detected by ELISA in patients with HCC, cirrhosis and chronic hepatis B and compared with each other. The diagnostic evaluation of the three tumor biomarkers alone or combined detection was used to analyze the sensitivity, specificity, the area under the curve and Youden index in the diagnosis of HCC. Results:The value of the three biomarkers in HCC patients were higher than those in cirrhosis and chronic hepatis B patients ( P < 0. 01) . In the cut-off value of 40 mAU/ml, 10% and 20 ng/ml for DCP, AFP-L3% and AFP,the sensitivity and specificity were 87. 88% and 95. 00% ,57. 58% and 90. 00% ,75. 76% and 63. 33% , respeclively. While when those in combination, the sensitivity and specificity were not better than DCP alone. Conclusions: Whether DCP,AFP-13% ,AFP are combined or alone for detection,DCP showes the best sensitivity and specificity for HCC diagnosis,so it can be used as main serum biomarker for diagnosis of HCC.