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摘要：
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摘要：目的 探讨血清miR-382-5p在丙型肝炎病毒（hepatitis C virus，HCV）相关肝细胞
癌（hepatocellular carcinoma，HCC）患者中的表达及其联合甲胎蛋白（alpha fetoprotein，
AFP）、异常凝血酶原-Ⅱ（protein induced by vitamin K antagonist-Ⅱ，PIVKA-Ⅱ）对
HCC诊断的价值。方法 选取2019年1月至2022年3月保定市人民医院收治的102例HCV相
关HCC患者（HCC组）、55例肝硬化患者（肝硬化组）和45例体检正常者（对照组）
为研究对象，比较各组血清miR-382-5p、AFP及PIVKA-Ⅱ水平，比较不同临床特征HCC
患者血清miR-382-5p的表达水平。应用受试者工作特征（receiver operator characteristic，
ROC）曲线分析血清miR-382-5p、AFP及PIVKA-Ⅱ水平对HCC的诊断价值。采用Pearson
相关分析HCC患者血清miR-382-5p表达水平与AFP及PIVKA-Ⅱ的相关性。结果 HCC组
血清miR-382-5p（6.83 ± 2.51比3.15 ± 1.08比1.82 ± 0.76）、AFP [（527.10 ± 73.26）μg/L
比（22.84 ± 9.25）μg/L比（3.17 ± 0.36）μg/L] 及PIVKA-Ⅱ [（352.64 ± 69.12）mAU/ml
比（21.73 ± 6.90）mAU/ml比（18.30 ± 4.27）mAU/ml] 水平均显著高于肝硬化组和对照
组（P均＜ 0.05）。TNM分期Ⅲ～Ⅳ期（8.70 ± 3.51比5.06 ± 1.80）、Child-Pugh分级C级
（8.14 ± 2.90比5.62 ± 1.91）、低分化（7.68 ± 2.70比6.11 ± 2.08）、门静脉癌栓（7.74 ±
2.73比6.04 ± 2.01）及远处转移（8.06 ± 2.84比5.71 ± 1.95）的HCC患者血清miR-382-5p表
达水平显著升高（P均＜ 0.05）。miR-382-5p、AFP及PIVKA-Ⅱ三项联合诊断HCC的ROC
曲线下面积最大（0.980，95%CI：0.918～0.997），其敏感度最高（98.5%）。相关分析
显示，HCC患者血清miR-382-5p水平与AFP（r = 0.795，P ＜ 0.001）和PIVKA-Ⅱ（r =
0.866，P ＜ 0.001）均呈正相关。结论 血清miR-382-5p水平在HCV相关HCC患者中显著升
高，联合AFP及PIVKA-Ⅱ检测可提高HCC的诊断价值。
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Abstract: Objective To investigate the expression of miR-382-5p in patients with hepatitis
C virus (HCV)-related hepatocellular carcinoma (HCC) and the value of its combination with
alpha fetoprotein (AFP) and protein induced by vitamin K antagonist-Ⅱ (PIVKA-Ⅱ) on
the diagnosis of HCC. Methods Total of 102 patients with HCV-related HCC (HCC group),
55 patients with liver cirrhosis (liver cirrhosis group) and 45 patients with normal physical
examination (control group) in Baoding People’s Hospital from January 2019 to March 2022
were selected. The levels of serum miR-382-5p, AFP and PIVKA-Ⅱ of patients in each group
were compared. The expression level of serum miR-382-5p of HCC patients with different
clinical characteristics were compared. Receiver operating characteristic (ROC) curve was
used to analyze the diagnostic value of serum miR-382-5p, AFP and PIVKA-Ⅱ levels for
HCC. The correlation between miR-382-5p expression level and AFP and PIVKA-Ⅱ in HCC
patients was analyzed by Pearson correlation analysis. Results The levels of serum miR-382-
5p (6.83 ± 2.51 vs. 3.15 ± 1.08 vs. 1.82 ± 0.76), AFP [(527.10 ± 73.26) μg/L vs. (22.84 ± 9.25) μg/L vs.
(3.17 ± 0.36) μg/L] and PIVKA-Ⅱ [(352.64 ± 69.12) mAU/ml vs. (21.73 ± 6.90) mAU/ml vs.
(18.30 ± 4.27) mAU/ml] of patients in HCC group were significantly higher than those in liver
cirrhosis group and control group (all P ＜ 0.05). The expression level of serum miR-382-5p
in patients with stage Ⅲ～Ⅳ (8.70 ± 3.51 vs. 5.06 ± 1.80), Child-Pugh grade C (8.14 ± 2.90 vs.
5.62 ± 1.91), poorly differentiation (7.68 ± 2.70 vs. 6.11 ± 2.08), portal vein tumor thrombus
(7.74 ± 2.73 vs. 6.04 ± 2.01) and distant metastasis (8.06 ± 2.84 vs. 5.71 ± 1.95) of HCC
increased significantly (all P ＜ 0.05). The area under ROC curve of miR-382-5p + AFP +
PIVKA-Ⅱ on the diagnosis of HCC was 0.980 (95% CI: 0.918～0.997), and the sensitivity
was 98.5%. Pearson correlation analysis showed that the level of serum miR-382-5p in
patients with HCC were positively correlated with AFP (r = 0.795, P ＜ 0.001) and PIVKA-Ⅱ
(r = 0.866, P ＜ 0.001). Conclusions The serum miR-382-5p level was significantly increased
in patients with HCV-associated HCC, and the combination of AFP and PIVKA-Ⅱ detection
could improve the diagnostic value of HCC.
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