AFP 在早期肝癌诊断中的临床价值研究

Clinical value of AFP in early diagnosis of hepatocelluar carcinoma

摘要:

目的 探讨血清肿瘤标记物甲胎蛋白（AFP）在早期肝癌诊断中的临床价值。方法 采用电化学发光法，检测71 例肝硬化患者、46 例早期肝癌患者、25 例中晚期肝癌患者血清甲胎蛋白含量，并分析其与肝癌的临床病理特点之间的关系。结果 肝硬化组血清logAFP 水平为（0.99±0.43）ng/ml，早期肝癌组为（1.79±0.84）ng/ml，晚期肝癌组为（2.66±1.24）ng/ml，3 组比较差异有统计学意义（P <0.05）；早期肝癌组与中晚期肝癌组logAFP 比较，差异有统计学意义（P <0.05），中晚期肝癌组AFP 水平高于早期肝癌组。血清AFP 水平与肿瘤体积呈正相关（P <0.05）。应用受试者工作特征曲线分析并确定早期肝癌诊断的最佳临界值，曲线下面积为0.824，最佳临界值为15.315 ng/ml，灵敏性为80.4%，特异性为69%。结论 AFP 对于早期肝癌的诊断，具有重要的临床价值，在临界浓度为15.315 ng/ml 时能提高早期肝癌诊断的灵敏性。

Abstract:

Objective To explore the value of serum tumor marker alpha-fetal protein (AFP) in the diagnosis of early hepatocellular carcinoma (HCC). Methods Serum level of AFP was detected by electrochemiluminescence method in 71 patients with liver cirrhosis, 46 patients with early HCC and 25 patients with advanced HCC. The relationships between the level of AFP and the HCC clinicopathological parameters were analyzed. Results The average level of logAFP was (0.99 ± 0.43) ng/ml in the liver cirrhosis group, (1.79 ± 0.84) ng/ml in the early HCC group and (2.66 ± 1.24) ng/ml in the advanced HCC group, there were significant differences by Kruskal-Wallis test(P < 0.05), the logAFP level in the advanced HCC group was signicantly higher than that in the early HCC group(P < 0.05). There was a positive correlation between the serum level of AFP and the tumor size (r = 0.440, P < 0.05).The area under the receiver operating characteristic curve (AUC) of AFP was 0.824. The sensitivity and specificity of AFP were 80.4% and 69% when the best cut-off value of AFP, 15.315 ng/ml, was definited; 69.6% and 78.9%,respectively, at a cut-off of 20 ng/ml. The cut-off of 15.315 ng/ml was more sensitive than 20 ng/ml and was the currently recommended clinical cut-off. Conclusions The level of serum AFP has significant value for diagnosis of HCC, and a cut-off of 15.315 ng/ml can improve its sensitivity in diagnosis of early HCC.