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目的评价血清甲胎蛋白(alpha-fetoprotein,AFP)对原发性肝细胞癌(hepatocellular carcinoma,HCC)的诊断价值。方法以病理确诊的HCC185例及肝炎肝硬化125例为研究对象,AFP测定采用微粒子酶联免疫法。将AFP测定值连续划分为9个数据段,计算敏感度、特异度、阳性似然比、阴性似然比、诊断优势比及准确度。应用SPSS16.0统计软件绘制受试者工作曲线(ROC),确定最适合临界值。Kaplan-Meier生存曲线分析不同AFP水平患者的生存率。结果 AFP Cut-off值为20μg/L时敏感度最高,为54.6%;400μg/L时特异度最高,为97.6%;250μg/L时,阳性似然比、特异度及诊断优势比均为最高,分别为12.838、97.6%及18.109,ROC曲线下面积最大,为0.722。AFP水平与年龄、性别、ALT水平、Child分级及HBeAg阳性与否无关。AFP<20μg/L的HCC患者2年生存率高于AFP≥20μg/L的患者(P<0.05),对于AFP<20μg/L的患者,手术治疗1年生存率高于非手术治疗(P<0.05)。结论对于HCC的诊断,AFP为250μg/L时效能最高。AFP水平与HCC患者预后有关。
Objective To evaluate the diagnostic value of serum alpha-fetoprotein (AFP) in primary hepatocellular carcinoma (HCC). Methods The pathological diagnosis of HCC185 cases and hepatitis cirrhosis in 125 cases for the study, AFP determination by particle enzyme-linked immunosorbent assay. AFP measured continuously divided into nine data segments, calculate the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and accuracy. Application of SPSS16.0 statistical software to draw the working curve of the subjects (ROC), to determine the most suitable critical value. Kaplan-Meier survival curves were analyzed for survival at different AFP levels. Results The highest sensitivity was 54.6% when the cut-off value of AFP was 20μg / L, the highest specificity was 97.6% at 400μg / L, and the positive likelihood ratio, specificity and diagnostic odds ratio were the highest at 250μg / L , Respectively 12.838, 97.6% and 18.109, with the area under the ROC curve being the largest at 0.722. AFP level and age, gender, ALT level, Child classification and HBeAg-positive or not. The 2-year survival rate of HCC patients with AFP <20μg / L was higher than that of patients with AFP≥20μg / L (P <0.05). The 1-year survival rate of patients with AFP <20μg / L was higher than that of non-surgical treatment 0.05). Conclusions For the diagnosis of HCC, AFP of 250μg / L has the highest efficacy. AFP levels and prognosis of patients with HCC.