CAJ | 학술논문

目的：评估联合检测腹腔积液细胞DNA倍体与微小RNA－21（miRNA－21）表达诊断肝细胞癌（HCC）的效能。方法将2012年1月1日－2014年1月1日鄂州市中心医院所收治临床表现伴有腹腔积液的患者纳入研究，HCC患者分入试验组，非HCC患者分入对照组。比较两组患者相关危险因素指标的差异性，采用Logistic回归分析进一步提取独立敏感指标，绘制相应指标的ROC曲线，计算曲线下面积（AUC）及约登指数（YI）。结果两组患者组间资料单因素比较显示：性别（男性比例）、吸烟史、HBV阳性、上腹部CT疑似阳性、卡氏功能量表（KPS量表）、ALT、甲胎蛋白（AFP）、异常凝血酶原（APT）、α－L－岩藻糖苷酶（AFU ）、腹水细胞miRNA－21、腹水细胞DNA异倍体阳性共计11项指标差异存在统计学意义（P值均＜0．05）。Logistic回归分析显示，吸烟史、AFP、APT、腹水细胞miRNA－21、腹水细胞DNA异倍体是诊断HCC的敏感指标。腹水细胞miRNA－21与DNA异倍体的AUC分别为0．742与0．801；吸烟史、AFP与APT三者联合断HCC的AUC为0．852，YI为0.5992。吸烟史、AFP、APT腹水细胞miRNA－21与DNA异倍体五项指标联合诊断的AUC增至0．869、YI增至0．6222。结论腹水细胞DNA异倍体与miRNA－21是诊断HCC的独立危险因素，单项指标检测即具有良好的诊断价值，将其联用能够显著增大HCC的诊断价值，对于该病的早期诊断具有重要临床意义，是当前HCC诊断体系的良好补充。
목적：평고연합검측복강적액세포DNA배체여미소RNA－21（miRNA－21）표체진단간세포암（HCC）적효능。방법장2012년1월1일－2014년1월1일악주시중심의원소수치림상표현반유복강적액적환자납입연구，HCC환자분입시험조，비HCC환자분입대조조。비교량조환자상관위험인소지표적차이성，채용Logistic회귀분석진일보제취독립민감지표，회제상응지표적ROC곡선，계산곡선하면적（AUC）급약등지수（YI）。결과량조환자조간자료단인소비교현시：성별（남성비례）、흡연사、HBV양성、상복부CT의사양성、잡씨공능량표（KPS량표）、ALT、갑태단백（AFP）、이상응혈매원（APT）、α－L－암조당감매（AFU ）、복수세포miRNA－21、복수세포DNA이배체양성공계11항지표차이존재통계학의의（P치균＜0．05）。Logistic회귀분석현시，흡연사、AFP、APT、복수세포miRNA－21、복수세포DNA이배체시진단HCC적민감지표。복수세포miRNA－21여DNA이배체적AUC분별위0．742여0．801；흡연사、AFP여APT삼자연합단HCC적AUC위0．852，YI위0.5992。흡연사、AFP、APT복수세포miRNA－21여DNA이배체오항지표연합진단적AUC증지0．869、YI증지0．6222。결론복수세포DNA이배체여miRNA－21시진단HCC적독립위험인소，단항지표검측즉구유량호적진단개치，장기련용능구현저증대HCC적진단개치，대우해병적조기진단구유중요림상의의，시당전HCC진단체계적량호보충。
Objective To evaluate the diagnostic value of combined determination of DNA ploidy level and microRNA-21 (miRNA-21) expression in ascites cells for hepatocellular carcinoma (HCC).Methods A total of 1 17 patients with ascites admitted to our hospital from January 1,2012 to January 1,2014 were enrolled.The patients with a confirmed diagnosis of HCC were assigned to experimental group (n=48),and those without HCC to control group (n=69).The risk factors for HCC were compared between the two groups.Logistic regres-sion analysis was used to extract independent sensitive indicators.The receiver operating characteristic (ROC)curve for each indicator was drawn,and the area under the ROC curve (AUC)and Youden index (YI)were calculated.Results Univariate analysis revealed signifi-cant differences between the two groups in sex (male ratio),smoking history,positive rate of HBV,proportion of suspected positive cases based on upper abdominal CT,Karnofsky Performance Scale score,alanine aminotransferase,alpha-fetoprotein (AFP),abnormal pro-thrombin (APT),α-L-fucosidase,miRNA-21 expression in ascites cells,and the positive rate of DNA aneuploidy in ascites cells (all P<0.05).Logistic regression analysis showed that smoking history,AFP,APT,miRNA-21 expression in ascites cells,and the positive rate of DNA aneuploidy in ascites cells were sensitive indicators for the diagnosis of HCC.The AUCs of miRNA-21 expression and positive rate of DNA aneuploidy were 0.742 and 0.801,respectively;the AUC and YI of combined use of smoking history,AFP,and APT were 0.852 and 0.5992,respectively,while the AUC and YI increased to 0.869 and 0.6222,respectively,if including miRNA-21 expression and positive rate of DNA aneuploidy in combined determination.Conclusion DNA aneuploidy and miRNA-21 in ascites cells are inde-pendent risk factors for HCC.The two indicators have good diagnostic values when used separately,and they show increased diagnostic val-ues when used in combination with other parameters (smoking history,AFP,and APT).Combined determination of these indicators has great clinical significance for the early diagnosis of HCC and is a good complement to the current HCC diagnosis system.