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目的 探讨在有肝实质占位病变 (spaceoccupinglesion ,SOL)时甲胎蛋白 (AFP)低浓度阳性 (AFP 2 1～ 2 0 0 μg/L)肝细胞癌 (HCC)患者的临床诊断。 方法 应用随机对照临床试验的方法对1993年 1月至 2 0 0 1年 6月经手术和病理学证实的 2 878例肝SOL进行临床流行病学分析。结果HCC组和非HCC组AFP的敏感性是 6 9 9% (16 5 0 /2 36 2 )和 8 9% (46 /5 16 ) ,特异性是 91 1% (470 /5 16 )和 30 1% (712 /2 36 2 ) ,阳性预测值是 97 3% (16 5 0 /16 96 )和 2 7% (46 /16 96 ) ,P值均小于 0 0 1。结论(1)在有肝SOL存在时 ,AFP低浓度升高也有重要诊断价值 ,并不需要等待AFP大于 2 0 0或 5 0 0 μg/L才能诊断HCC ;(2 )提出低甲胎蛋白浓度HCC的概念有利于在AFP较低浓度时作出HCC的早期诊断 ,可减少 18%AFP 2 1～ 2 0 0 μg/LHCC患者的漏诊 ;(3)用AFP大于 2 0 μg/L结合B型超声、CT等联合诊断 ,提高了单一诊断手段的敏感性和特异性
Objective To investigate the clinical diagnosis of hepatocellular carcinoma (HCC) with a low concentration of AFP (AFP 2 1 ~ 200 μg / L) in patients with space occupying lesion (SOL). Methods The clinical epidemiological analysis of 2 878 liver surgeries confirmed by surgery and pathology from January 1993 to June 2001 was performed by randomized controlled clinical trial. Results The sensitivity of AFP in HCC group and non-HCC group was 69.9% (165/326) and 89% (46/51) respectively, and the specificity was 91.1% (470/516) and 30 The positive predictive value was 97 3% (16 5 0/16 16) and 27% (46/16 96), respectively. The P values were all less than 0 0 1. Conclusions (1) There is also an important diagnostic value of low AFP concentration in the presence of hepatic SOL without waiting for AFP greater than 200 or 500 μg / L to diagnose HCC. (2) To propose a low alpha-fetoprotein concentration The concept of HCC facilitates the early diagnosis of HCC at a lower concentration of AFP and can reduce the misdiagnosis of 18% of patients with AFP 2 1 ~ 200 μg / LHCC; (3) with AFP greater than 20 μg / L combined with type B ultrasound , CT and other joint diagnosis, improve the sensitivity and specificity of a single diagnostic tool