临床肝胆病杂志
臨床肝膽病雜誌
림상간담병잡지
CHINESE JOURNAL OF CLINICAL HEPATOLOGY
2014年
8期
785-789
,共5页
丁艳%李丹%王念跃%耿全林
丁豔%李丹%王唸躍%耿全林
정염%리단%왕념약%경전림
肝疾病%高尔基蛋白73%甲胎蛋白异质体%甲胎蛋白类%α-L-岩藻糖苷酶
肝疾病%高爾基蛋白73%甲胎蛋白異質體%甲胎蛋白類%α-L-巖藻糖苷酶
간질병%고이기단백73%갑태단백이질체%갑태단백류%α-L-암조당감매
liver diseases%golgi protein 73(GP73)%alpha-fetoproteins L3%alpha-fetoproteins%alpha-L-fucosidase
目的：比较高尔基蛋白73（GP73）、甲胎蛋白异质体3（AFP-L3）、甲胎蛋白（AFP）和α-L-岩藻糖苷酶（AFU）在不同肝脏疾病患者中的意义及其单项或联合检测诊断肝癌的价值。方法对2013年1-12月收治的272例肝癌患者、203例肝硬化患者、248例慢性肝炎患者及210例健康体检者血清中的GP73、AFP-L3、AFP和AFU水平进行检测。非正态分布的数据多组间比较采用Kruskal-Wallis H检验，组间两两比较采用Mann-Whitney U检验，率的比较用卡方检验。ROC曲线绘制分别以健康人组和非肝癌组（健康体检、慢性肝炎、肝硬化）为对照。联合指标先进行 Logistic 拟合后再做 ROC 曲线。结果 GP73水平肝硬化组[177．0（116．0，247．0）ng/ml]较肝癌组[141．0（83．3，218．8）ng/ml]）和慢性肝炎组[151．0（83．0，235．3）ng/ml]高（U＝22116．5、21052．0，P均＜0．05）；AFP-L3和AFP在肝癌组中的水平[11．3（4．3，21．2）％，78．4（7．1，2455.8）ng/ml]明显高于肝硬化组[6.0（4．0，8．0）％，10．0（3．8，49．5）ng/ml]和慢性肝炎组[7．0（5．0，9．0）％，18．8（4．4，79.6）ng/ml]（P均＜0．05）。以健康人血清样本为对照绘制的诊断肝癌的ROC曲线，GP73、AFP-L3、AFP和AFU的ROC曲线下面积（AUC）分别为0.827、0.817、0．901和0．680。由此可知在鉴别健康人和肝癌患者方面，前3者比AFU有较高的准确性。以非肝癌患者血清样本为对照绘制的诊断肝癌的ROC曲线，4个指标对应的AUC分别为0．573、0．734、0．753和0．552，可见AFP-L3和AFP对于诊断肝癌有一定的准确性，其敏感性和特异性达到最大时的cut off值依次为8．55％（56．6％，84．9％），49．88 ng/ml（57.7％，80．9％）。结论 GP73的上升与肝损伤及长期纤维化有关，其在诊断肝脏疾病中有较好的敏感性，AFP-L3和AFP在诊断肝癌方面特异性较好，AFP-L3和AFP两者联合应用可提高肝癌的诊断敏感性至62．1％。
目的：比較高爾基蛋白73（GP73）、甲胎蛋白異質體3（AFP-L3）、甲胎蛋白（AFP）和α-L-巖藻糖苷酶（AFU）在不同肝髒疾病患者中的意義及其單項或聯閤檢測診斷肝癌的價值。方法對2013年1-12月收治的272例肝癌患者、203例肝硬化患者、248例慢性肝炎患者及210例健康體檢者血清中的GP73、AFP-L3、AFP和AFU水平進行檢測。非正態分佈的數據多組間比較採用Kruskal-Wallis H檢驗，組間兩兩比較採用Mann-Whitney U檢驗，率的比較用卡方檢驗。ROC麯線繪製分彆以健康人組和非肝癌組（健康體檢、慢性肝炎、肝硬化）為對照。聯閤指標先進行 Logistic 擬閤後再做 ROC 麯線。結果 GP73水平肝硬化組[177．0（116．0，247．0）ng/ml]較肝癌組[141．0（83．3，218．8）ng/ml]）和慢性肝炎組[151．0（83．0，235．3）ng/ml]高（U＝22116．5、21052．0，P均＜0．05）；AFP-L3和AFP在肝癌組中的水平[11．3（4．3，21．2）％，78．4（7．1，2455.8）ng/ml]明顯高于肝硬化組[6.0（4．0，8．0）％，10．0（3．8，49．5）ng/ml]和慢性肝炎組[7．0（5．0，9．0）％，18．8（4．4，79.6）ng/ml]（P均＜0．05）。以健康人血清樣本為對照繪製的診斷肝癌的ROC麯線，GP73、AFP-L3、AFP和AFU的ROC麯線下麵積（AUC）分彆為0.827、0.817、0．901和0．680。由此可知在鑒彆健康人和肝癌患者方麵，前3者比AFU有較高的準確性。以非肝癌患者血清樣本為對照繪製的診斷肝癌的ROC麯線，4箇指標對應的AUC分彆為0．573、0．734、0．753和0．552，可見AFP-L3和AFP對于診斷肝癌有一定的準確性，其敏感性和特異性達到最大時的cut off值依次為8．55％（56．6％，84．9％），49．88 ng/ml（57.7％，80．9％）。結論 GP73的上升與肝損傷及長期纖維化有關，其在診斷肝髒疾病中有較好的敏感性，AFP-L3和AFP在診斷肝癌方麵特異性較好，AFP-L3和AFP兩者聯閤應用可提高肝癌的診斷敏感性至62．1％。
목적：비교고이기단백73（GP73）、갑태단백이질체3（AFP-L3）、갑태단백（AFP）화α-L-암조당감매（AFU）재불동간장질병환자중적의의급기단항혹연합검측진단간암적개치。방법대2013년1-12월수치적272례간암환자、203례간경화환자、248례만성간염환자급210례건강체검자혈청중적GP73、AFP-L3、AFP화AFU수평진행검측。비정태분포적수거다조간비교채용Kruskal-Wallis H검험，조간량량비교채용Mann-Whitney U검험，솔적비교용잡방검험。ROC곡선회제분별이건강인조화비간암조（건강체검、만성간염、간경화）위대조。연합지표선진행 Logistic 의합후재주 ROC 곡선。결과 GP73수평간경화조[177．0（116．0，247．0）ng/ml]교간암조[141．0（83．3，218．8）ng/ml]）화만성간염조[151．0（83．0，235．3）ng/ml]고（U＝22116．5、21052．0，P균＜0．05）；AFP-L3화AFP재간암조중적수평[11．3（4．3，21．2）％，78．4（7．1，2455.8）ng/ml]명현고우간경화조[6.0（4．0，8．0）％，10．0（3．8，49．5）ng/ml]화만성간염조[7．0（5．0，9．0）％，18．8（4．4，79.6）ng/ml]（P균＜0．05）。이건강인혈청양본위대조회제적진단간암적ROC곡선，GP73、AFP-L3、AFP화AFU적ROC곡선하면적（AUC）분별위0.827、0.817、0．901화0．680。유차가지재감별건강인화간암환자방면，전3자비AFU유교고적준학성。이비간암환자혈청양본위대조회제적진단간암적ROC곡선，4개지표대응적AUC분별위0．573、0．734、0．753화0．552，가견AFP-L3화AFP대우진단간암유일정적준학성，기민감성화특이성체도최대시적cut off치의차위8．55％（56．6％，84．9％），49．88 ng/ml（57.7％，80．9％）。결론 GP73적상승여간손상급장기섬유화유관，기재진단간장질병중유교호적민감성，AFP-L3화AFP재진단간암방면특이성교호，AFP-L3화AFP량자연합응용가제고간암적진단민감성지62．1％。
Objective To compare the levels of Golgi glycoprotein 73 (GP73 ),alpha-fetoprotein heterogeneity 3 (AFP-L3 ),alpha-fetoprotein (AFP),and α-L-fucosidase (AFU)between patients with different liver diseases and the diagnostic value of any or a combi-nation of these makers for liver cancer.Methods The 272 patients with liver cancer,203 patients with liver cirrhosis,and 248 patients with chronic hepatitis admitted to our hospital from January to December,2013,as well as 210 healthy individuals,were included in the study.Serum levels of GP73,AFP-L3,AFP,and AFU were determined.Comparison of non -normally distributed data was made by Kruskal-Wallis H test,and multiple comparisons were made by Mann-Whitney U test.Comparison of rates was made by chi-square test. P<0.05 was considered significantly different.Receiver operating characteristic (ROC)curves were drawn with healthy individuals and pa-tients with chronic hepatitis or liver cirrhosis as controls,and Logistic fitting and ROC analysis were used to evaluate the diagnostic values of these markers.Results The GP73 level of liver cirrhosis group (177.0 (116.0,247.0)ng/ml)was significantly higher than those of liver cancer group (141.0 (83.3,218.8)ng/ml)and chronic hepatitis group (151.0 (83.0,235.3)ng/ml)(U=22 116.5 and 21 052.0,P<0.05 for both).The AFP-L3 and AFP levels of liver cancer group (11.3 (4.3,21.2)%and 78.4 (7.1,2455.8)ng/ml)were significantly higher than those of liver cirrhosis group (6.0 (4.0,8.0)%and 10.0 (3.8,49.5)ng/ml)and chronic hepatitis group (7.0 (5.0,9.0)%and 18.8 (4.4,79.6)ng/ml)(U=16009.0/16083.5 and 22456.5/22346.5,P<0.05 for all).According to the ROC curves drawn u-sing healthy individuals as a control,the areas under the ROC curve (AUCs)for GP73,AFP-L3,AFP,and AFU were 0.827,0.817, 0.901,and 0.680,respectively;GP73,AFP-L3,and AFP had a higher diagnostic accuracy for liver cancer than AFU.According to the ROC curves drawn using non-liver cancer patients as a control,the AUCs for the four markers were 0.573,0.734,0.753,and 0.552,re-spectively;AFP-L3 and AFP had some diagnostic accuracy for liver cancer,and their cut-off values were 8.55% (56.6%,84.9%) and 49.88 ng/ml (57.7%,80.9%),respectively,when the sensitivity and specificity reached the peak values.Conclusion Increased GP73 is related to hepatic impairment and chronic fibrosis,and it has a better sensitivity for the diagnosis of liver diseases.AFP-L3 and AFP have good specificity for the diagnosis of liver cancer,and a combination of the two markers can increase the diagnostic sensitivity for liver cancer to 62.1%.
