目的 探讨高尔基体蛋白73(GP73)联合甲胎蛋白(AFP)对肝细胞性肝癌(HCC)早期诊断和复发监测的价值.方法 研究共收集140例血清,来自东莞康华医院2010年1月～12月间门诊或住院患者及体检者,其中90例为体检正常者(正常对照)和50例HCC患者.酶联免疫吸附试验(ELISA)定量测定两组人群中GP73蛋白的表达；采用电化学发光法(ECL)检测相应人群血清中的AFP的量,计算ROC曲线下面积及GP73和AFP对HCC诊断的敏感度和特异度.结果 ①HCC组及正常对照组GP73水平分别为(279.2±126.4)μg/L和(41.2±26.9)μg/L；AFP分别为(285.4±270.2)μg/L和(4.35±3.64) μg/L. HCC组GP73和AFP均明显高于正常对照组(u分别为2.87,3.02,P＜0.01)；②GP73和AFP用于诊断HCC的受试者工作特征曲线(ROC曲线)下面积分别为0.857和0.832,此时的敏感度分别为74.0％和52.0％,特异度分别为91.1％和87.7％,二者联合检测的敏感度为82.0％,特异度为93.3％.③通过对4例AFP＜400μg/L的HCC患者连续监测表明,GP73与治疗效果及预后有一定的相关性.结论 GP73可用于HCC高危人群的普查和筛选,是单独检测HCC的理想血清标志物,而AFP及GP73的联合使用可有效提高HCC的诊断率,并对HCC的复发有较大的监测作用.%Objective To evaluate the possibility of using GP73 combined AFP on early diagnosis and recurrence monitoring value of HCC. Methods ELTSA assay was used to detect the serum GP73 level in 90 healthy donors (Normal) ,and 50 HCC patients. Serum α-fetoprotein (AFP) was detected by electrochemilumnescence reaction. The receiver operating curve (ROC) ,sensitivity and specialty of GP73 and AFP for HCC patients were calculated. Results ①Serum GP73 levels in the HCC and healthy groups were (279. 2±126.4)μg/L and (41. 2±26. 9)μg/L,respectively,and AFP were (285. 4±270.2) μg/L and (4. 35 ±3. 64) μg/L respectively. GP73 and AFP levels were significantly higher in patients PHC compared with it in healthy groups (u:2. 87,3. 02, P<0. 01). ②Areas under the ROC curves of GP73 and AFP were 0. 857 and 0. 832,respectively, with sensitivity of 74.0% and 52.0% and specificity of 91.1 %,87. 7%. Combined detection of the two parameters could improve the sensitivity up to 82. 0% and maintain a high specificity of 93. 3%. ③Following-up study of 4 HCC patients with low level AFP indicated that GP73 were associated with treatment and prognostics of HCC. Conclusion GP73 can be used for HCC high-risk groups of census and screening. It is an ideal of HCC testing alone serum marker, and the joint detection of GP73 and AFP can effectively improve the diagnosis of HCC,and in the recurrence, HCC play a bigger monitoring role.
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