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摘要: 目的：探讨血清中甲胎蛋白（AFP）、异常凝血酶原Ⅱ（PIVKA-Ⅱ）、α-L-岩藻糖苷酶（AFU）联合检测对原发性肝癌（HCC）的诊断价值。方法：选择2018年1月-2019年7月住院的172例肝病患者为研究对象，其中HCC患者62例（HCC组）、肝硬化患者54例（肝硬化组）、慢性乙型肝炎患者56例（慢性乙型肝炎组）。采用化学发光法检测AFP、PIVKA-Ⅱ，酶动力学法检测AFU，比较各组水平差异；采用秩和检验和受试者工作特性曲线（ROC）分析三者在HCC诊断中的价值。结果：HCC组的AFP、PIVKA-Ⅱ和AFU水平均显著高于肝硬化组和慢性乙型肝炎组（P<0.05）；ROC曲线分析显示：AFP、PIVKA-Ⅱ和AFU用于诊断HCC的ROC曲线下面积分别为0.801、0.886和0.653。单项检测中，AFP的敏感度最高，为79.96%；PIVKA-Ⅱ的特异度与准确度均最高，分别为89.13%与83.77%。联合检测中，AFP+PIVKA-Ⅱ组合的准确度最高，为85.82%，AFP+PIVKA-Ⅱ+AFU的特异度最高，为98.80%；并联实验中AFP/PIVKA-Ⅱ/AFU组合的敏感度最高，为88.71%。结论：AFP、PIVKA-Ⅱ、AFU联合检测可以提高对HCC的诊断效能，弥补了单项检测的不足。Abstract: Objective: To explore the diagnostic value of semm tumor markers alpha-fetoprotein(AFP), protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ), α-L-fucosidase(AFU) in the primary hepatic carcinoma(HCC). Methods: One hundred and seventy-two patients with liver disease from January 2018 to July 2019 were selected, 62 case with HCC patients(HCC group), 54 case of cirrhotic patients(liver cirrhosis group), and 56 case of chronic hepatitis B(chronic hepatitis B group). The serum levels of AFP and PIVKA-Ⅱwere detected by the method of chemiluminescent immunoassay; AFU was detected by enzyme-dynamic assay. The level differences of each group were compared, rank sum test and receiver operating characteristic curve(ROC) were used to analyze the value of the three markers in the diagnosis of HCC. Results: AFP, PIVKA-Ⅱ and AFU levels in HCC group were significantly higher than that of liver cirrhosis group and chronic hepatitis group(P<0.05); ROC curve analysis showed that the AFP, PIVKA Ⅱ and AFU area under the ROC curve applied to diagnosis of primary liver cancer was 0.801, 0.886 and 0.653, respectively. Among the single detection, AFP had the highest sensitivity of 79.96%, PIVKA-Ⅱ had the highest specificity and accuracy of 89.13% and 83.77%, respectively. In the combined detection, AFP+PIVKA Ⅱ combination had the highest accuracy of 85.82%; AFP+PIVKA-Ⅱ+AFU combination had the highest specificity of 98.80%; AFP/PIVKA-Ⅱ/AFU had the highest sensitivity of 88.71%. Conclusion: AFP, PIVKA-Ⅱand AFU combined detection can improve the efficiency to the diagnosis of primary liver cancer, makes up for the lack of single detection.
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