CAJ | 학술논문

目的：研究血清异常凝血酶原[又称维生素K缺乏或拮抗剂Ⅱ诱导的蛋白质（PIVKA-Ⅱ）]检测在临床原发性肝癌诊断中的价值及意义。方法收集瑞金医院住院365例患者的血清，其中100例为原发性肝癌患者血清，265例为非原发性肝癌者血清（包括慢性肝病59例、消化系统肿瘤50例、继发性肝癌50例、其他肝脏病变56例和正常对照50例）。采用罗氏Cobas e601全自动免疫分析仪和LUMIPULSE G1200全自动免疫分析仪分别检测血清标本甲胎蛋白（AFP）和PIVKA-Ⅱ水平。所有数据采用SPSS 16．0分析软件进行统计学分析。结果原发性肝癌组血清AFP和PIVKA-Ⅱ水平均明显高于其他疾病组和正常对照组（P＜0．01）。血清AFP单独诊断原发性肝癌敏感性为63．00％，特异性为84．91％；血清PIVKA-Ⅱ单独诊断原发性肝癌敏感性为74．00％，特异性为89．81％。受试者工作特征（ROC）曲线分析结果显示，AFP和PIVKA-Ⅱ曲线下面积分别为0．789和0．873。采用PIVKA-Ⅱ和AFP不同的联合诊断方案，可将诊断原发性肝癌的敏感性和特异性分别提高到81．0％和98．49％。结论血清PIVKA-Ⅱ用于原发性肝癌的诊断价值优于AFP，可作为临床诊断原发性肝癌的肿瘤标志物，其与AFP的联合检测可大大提高原发性肝癌的诊断敏感性和特异性。
목적：연구혈청이상응혈매원[우칭유생소K결핍혹길항제Ⅱ유도적단백질（PIVKA-Ⅱ）]검측재림상원발성간암진단중적개치급의의。방법수집서금의원주원365례환자적혈청，기중100례위원발성간암환자혈청，265례위비원발성간암자혈청（포괄만성간병59례、소화계통종류50례、계발성간암50례、기타간장병변56례화정상대조50례）。채용라씨Cobas e601전자동면역분석의화LUMIPULSE G1200전자동면역분석의분별검측혈청표본갑태단백（AFP）화PIVKA-Ⅱ수평。소유수거채용SPSS 16．0분석연건진행통계학분석。결과원발성간암조혈청AFP화PIVKA-Ⅱ수평균명현고우기타질병조화정상대조조（P＜0．01）。혈청AFP단독진단원발성간암민감성위63．00％，특이성위84．91％；혈청PIVKA-Ⅱ단독진단원발성간암민감성위74．00％，특이성위89．81％。수시자공작특정（ROC）곡선분석결과현시，AFP화PIVKA-Ⅱ곡선하면적분별위0．789화0．873。채용PIVKA-Ⅱ화AFP불동적연합진단방안，가장진단원발성간암적민감성화특이성분별제고도81．0％화98．49％。결론혈청PIVKA-Ⅱ용우원발성간암적진단개치우우AFP，가작위림상진단원발성간암적종류표지물，기여AFP적연합검측가대대제고원발성간암적진단민감성화특이성。
Objective To investigate the significance of serum abnormal prothrombin [protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)]in clinical diagnosis of primary hepatocellular carcinoma.Methods There were 365 samples from inpatients in Ruijin Hospital,including 100 patients with primary hepatocellular carcinoma and the other 265 patients with no primary hepatocellular carcinoma (59 cases of chronic liver disease,50 cases of gastrointestinal cancer,50 cases of secondary liver cancer,56 cases of other hepatopathy and 50 cases of healthy controls).Serum alpha fetoprotein (AFP)and PIVKA-Ⅱlevels were detected by Roche Cobas e601 automatic immunity analyzer and LUMIPULSE G1200 automatic immunity analyzer,respectively.Data were analyzed statistically by SPSS 16.0 software.Results Serum AFP and PIVKA-Ⅱlevels were significantly higher in primary hepatocellular carcinoma group than those in other disease group and healthy controls.Serum AFP had a sensitivity of 63.00%and a specificity of 84.91% in the diagnosis of primary hepatocellular carcinoma,while PIVKA-Ⅱhad a sensitivity of 74.00% and a specificity of 89.81%.The results of receiver operating characteristic (ROC)curve showed that the areas under the curve of AFP and PIVKA-Ⅱwere 0.789 and 0.873,respectively.The diagnosis sensitivity and specificity of the combination determination of AFP and PIVKA-Ⅱreached to 81.00% and 98.49%.Conclusions Serum PIVKA-Ⅱhas a better diagnosis significance than AFP,and can be a tumor marker in the diagnosis of primary hepatocellular carcinoma.Moreover,the combination determination of AFP and PIVKA-Ⅱcan improve the diagnosis efficiency for clinical primary hepatocellular carcinoma.