CAJ | 학술논문

目的：探讨不同血清肿瘤标志物在肝硬化和肝癌的鉴别诊断中的临床价值。方法回顾性分析146例肝硬化患者、50例原发性肝癌患者的临床资料，并选取50例健康体检者作为对照，分别检测血清AFP、甲胎蛋白异质体（AFP-L3）和高尔基体糖蛋白73（GP73）含量，并计算 AFP-L3％。结果146例肝硬化患者的 AFP 阳性率为平均25．3％，低于肝癌组的72％（χ2＝34．69，P＜0．01）；AFP-L3％在不同病因肝硬化组中阳性率均较低，平均8．9％，低于肝癌组的58％（χ2＝53．32，P＜0．01），也低于肝硬化组中AFP 的阳性率（χ2＝13．90，P＝0．0002）；GP73在不同病因肝硬化组、肝癌组阳性率均较高，在肝硬化组中平均阳性率为74．7％，高于AFP 及AFP-L3％在肝硬化组中的阳性率（χ2＝71．01，P＜0．01），与GP73在肝癌组中的阳性率比较差异无统计学意义（χ2＝0．84，P＝0．36）。AFP、AFP-L3％的敏感性、特异性均较GP73好，联合诊断不能提高鉴别准确性。结论血清肿瘤标志物AFP 在乙型肝炎肝硬化及隐源性肝硬化患者中阳性率较高，AFP-L3％在各种病因肝硬化患者中均较低，AFP、AFP-L3％可有效区分肝癌和肝硬化；GP73在不同病因肝硬化组中均高，不能用于区分肝硬化和肝癌。
목적：탐토불동혈청종류표지물재간경화화간암적감별진단중적림상개치。방법회고성분석146례간경화환자、50례원발성간암환자적림상자료，병선취50례건강체검자작위대조，분별검측혈청AFP、갑태단백이질체（AFP-L3）화고이기체당단백73（GP73）함량，병계산 AFP-L3％。결과146례간경화환자적 AFP 양성솔위평균25．3％，저우간암조적72％（χ2＝34．69，P＜0．01）；AFP-L3％재불동병인간경화조중양성솔균교저，평균8．9％，저우간암조적58％（χ2＝53．32，P＜0．01），야저우간경화조중AFP 적양성솔（χ2＝13．90，P＝0．0002）；GP73재불동병인간경화조、간암조양성솔균교고，재간경화조중평균양성솔위74．7％，고우AFP 급AFP-L3％재간경화조중적양성솔（χ2＝71．01，P＜0．01），여GP73재간암조중적양성솔비교차이무통계학의의（χ2＝0．84，P＝0．36）。AFP、AFP-L3％적민감성、특이성균교GP73호，연합진단불능제고감별준학성。결론혈청종류표지물AFP 재을형간염간경화급은원성간경화환자중양성솔교고，AFP-L3％재각충병인간경화환자중균교저，AFP、AFP-L3％가유효구분간암화간경화；GP73재불동병인간경화조중균고，불능용우구분간경화화간암。
Objective To investigate the difference of serum AFP,AFP-L3% and GP73in different types of liver cirrhosis and their differential diagnostic value between liver cirrhosis and liver cancer. Methods One hundred and forty-six cases of liver cirrhosis patients from August 2012 to August 2013 were analyzed,while 50 primary hepatic carcinoma (PHC)and 50 healthy controls were enrolled. Serum AFP,AFP-L3 and GP73 were measured respectively and AFP-L3% was calculated. Results The top three causes of liver cirrhosis were hepatitis B virus, cryptogenic and autoimmunity. The positive rate of AFP in hepatitis virus groups and cryptogenic cirrhosis group was high,but significantly lower than that of PHC group. AFP-L3% positive rate was low in all types of liver cirrhosis groups and significantly lower than that of PHC and the positive rate of AFP in liver cirrhosis. GP73 rose in all types of liver cirrhosis and showed no difference between liver cirrhosis and PHC group. AFP and AFP-L3% showed better sensitivity and specificity than GP73 . However,different markers combination didn’t present more accuracy than single marker. Conclusions The positive rate of AFP is high in hepatitis virus-related cirrhosis and cryptogenic cirrhosis while AFP-L3% is low in all types of liver cirrhosis. AFP and AFP-L3% could high-performance distinguish liver cirrhosis from liver cancer. GP73 increases in all types of liver cirrhosis. So it could not distinguish liver cirrhosis from liver cancer.