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目的:探讨人血清磷脂酸肌醇蛋白聚糖-3(GlyPican-3)和甲胎蛋白(α-fetoprotein,AFP)联合检测对肝细胞癌(hepatocellular carcinoma,HCC)诊断的临床价值。方法:收集2011-11-02-2013-01-13遵义市第一人民医院174例和青岛市城阳区人民医院44例,门诊和肝胆外科人外周血血清218例,其中HCC 54例,肝硬化36例,肝炎40例,肝良性肿瘤18例,其他恶性肿瘤40例,健康志愿者30名。双抗体夹心酶联免疫定量测定方法和电化学发光法检测血清中Gly Pican-3和AFP的表达水平,结果以中位数(M)表示。制作受试者工作特征(receiver operating characteristic,ROC)曲线,以曲线下面积(area under curve,AUC)反映诊断的准确性。结果:HCC组血清GlyPican-3的表达水平为654.67ρg/mL,显著高于肝硬化组的32.83ρg/mL、肝炎组的33.04ρg/mL、肝良性肿瘤组的15.14ρg/mL、其他恶性肿瘤组的25.82ρg/mL和健康志愿者组的3.90ρg/mL,P值均<0.001;GlyPican-3组AUC为0.883,95%CI:0.833~0.923;AFP组为0.802,95%CI:0.743~0.853;GlyPican-3和AFP联合检测为0.945,95%CI:0.905~0.971。GlyPican-3和AFP联合检测显著高于单个检测指标,Z值分别为5.944和3.409,P值分别为<0.001和0.007。GlyPican-3取最佳临界值为60ρg/mL时,GlyPican-3诊断HCC的灵敏度和特异度分别为85.18%(46/54)和73.78%(121/164);GlyPican-3联合AFP检测诊断HCC的灵敏度可达96.29%(52/54)。血清GlyPican-3的表达水平随HCC的临床分期增加而升高,H=4.571,P=0.025。结论:血清GlyPican-3的表达水平对于HCC具有较高的诊断价值,血清GlyPican-3联合AFP检测可提高HCC的诊断率。血清GlyPican-3的表达水平与临床分期有关。
Objective: To investigate the clinical value of combined detection of serum glypican-3 and α-fetoprotein (AFP) in the diagnosis of hepatocellular carcinoma (HCC). Methods: Totally 174 cases of First People’s Hospital of Zunyi City and 44 cases of People’s Hospital of Chengyang District of Qingdao City were collected during the period of 2011-11-02-2013-01-13. There were 218 cases of peripheral blood serum from clinic and hepatobiliary surgery, including 54 cases of HCC, 36 cases of sclerosis, 40 cases of hepatitis, 18 cases of benign liver tumor, 40 cases of other malignant tumors, 30 healthy volunteers. Serum levels of Gly Pican-3 and AFP were measured by double antibody sandwich enzyme-linked immunosorbent assay and electrochemiluminescence. The median (M) values were obtained. Receiver operating characteristic (ROC) curves were generated and the diagnostic accuracy was expressed as the area under curve (AUC). Results: The expression level of GlyPican-3 in HCC group was 654.67 pg / mL, which was significantly higher than that in cirrhosis group (32.83 pg / mL, 33.04 pg / mL in hepatitis group, 15.14 pg / mL in benign liver tumor group) P value was less than 0.001 in the 25.82 pg / mL group and 3.90 pg / mL in the healthy volunteer group, AUC was 0.883, 95% CI: 0.833-0.923 in the GlyPican-3 group, 0.802, 95% CI 0.743 ~ 0.853; Combined detection of GlyPican-3 and AFP was 0.945, 95% CI: 0.905-0.971. The combined detection of GlyPican-3 and AFP was significantly higher than the single detection index, with Z values of 5.944 and 3.409, respectively, with P values of <0.001 and 0.007, respectively. The sensitivity and specificity of GlyPican-3 in diagnosis of HCC were 85.18% (46/54) and 73.78% (121/164) respectively when GlyPican-3 was taken as the optimal cut-off value of 60 pg / mL. GlyPican- The sensitivity can reach 96.29% (52/54). Serum GlyPican-3 expression levels increased with the clinical stage of HCC, H = 4.571, P = 0.025. Conclusion: The expression level of serum GlyPican-3 is of high diagnostic value for HCC. The serum GlyPican-3 combined with AFP detection can improve the diagnostic rate of HCC. Serum GlyPican-3 expression levels and clinical stage related.