血清甲胎蛋白、甲胎蛋白异质体3比率、高尔基体蛋白73水平对乙型肝炎相关原发性肝癌的诊断价值

作者：袁文利  汤磊  张振华  邹桂舟

单位：安徽医科大学第二附属医院 感染科 安徽 合肥 230601

关键词：肝炎病毒 乙型 肝硬化 原发性肝癌 甲胎蛋白 甲胎蛋白异质体3比率 高尔基体跨膜糖蛋白73

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出版年,卷(期):页码：2024,16(3):17-21

摘要：

摘要：目的 探讨血清甲胎蛋白（alpha fetoprotein，AFP）、甲胎蛋白异质体3比率（alphafetoprotein- L-3 ratio，AFP-L3%）和高尔基体蛋白73（golgi protein73，GP73）水平对乙 型肝炎相关原发性肝癌（primary liver cancer，PLC）的诊断价值。方法 以2018年1月至 2023年7月安徽医科大学第二附属医院肝病科门诊和住院的182例乙型肝炎病毒（hepatitis B virus，HBV）感染者为研究对象，其中原发性肝癌患者60例（PLC组），肝硬化患者 85例（肝硬化组），慢性乙型肝炎（chronic hepatitis B，CHB）患者37例（肝炎组）， 检测各组患者血清AFP、AFP-L3%和GP73水平。采用受试者工作特征（receiver operating characteristic，ROC）曲线评价AFP、AFP-L3%、GP73及联合检测对PLC的诊断效能。结 果 PLC组患者AFP（中位数：116 μg/L比5.32 μg/L比5.08 μg/L）、AFP-L3%（中位数： 5.23 μg/L比0 μg/L比0 μg/L）水平显著高于肝硬化组和肝炎组（P均＜ 0.05），3组间GP73 水平差异无统计学意义（中位数：84.09 μg/L比95.22 μg/L比64.57 μg/L；H = 1.52，P = 0.47）。AFP、AFP-L3%、GP73、AFP + AFP-L3%和AFP + AFP-L3 % + GP73诊断PLC的 ROC曲线下面积分别为0.79、0.78、0.49、0.83、0.81。三者联合诊断的特异度（89.10%） 和总有效率（81.82%）最高。结论 AFP和AFP-L3%作为PLC的辅助诊断指标时具有良好 的诊断价值，而GP73的诊断价值相对较低。AFP、AFP-L3%、GP73联合检测可提高PLC 诊断的特异度，对PLC诊断具有较高的临床价值。

Abstract: Objective To investigate the diagnostic value of alpha fetoprotein (AFP), alphafetoprotein- L-3 ratio (AFP-L3%) and golgi protein 73 (GP73) on hepatitis B-related primary liver cancer (PLC). Method A total of 182 patients with hepatitis B virus infection who were admitted to the outpatient and inpatient department of the Department of Infectious Diseases, Second Affiliated Hospital of Anhui Medical University from January 2018 to July 2023 were selected. Among them, there were 60 patients with primary liver cancer (PLC group), 85 patients with liver cirrhosis (liver cirrhosis group) and 37 patients with chronic hepatitis B (CHB group). Serum AFP, AFP-L3%, and GP73 levels of patients in each group were detected. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of AFP, AFP-L3%, GP73 and combined detection on PLC. Results The levels of AFP (median: 116 μg/L vs. 5.32 μg/L vs. 5.08 μg/L) and AFP-L3% (median:5.23 μg/L vs. 0 μg/L vs. 0 μg/L) of patients in liver cancer group were significantly higher than those of liver cirrhosis group and CHB group (all P ＜ 0.05), while there was no statistically significant difference in GP73 levels among the three groups (median: 84.09 μg/L vs. 95.22 μg/L vs. 64.57 μg/L; H = 1.52, P = 0.47). The area under the ROC curve for diagnosing PLC of AFP, AFP-L3%, GP73, AFP + AFP-L3% and AFP + AFP-L3% + GP73 were 0.79, 0.78, 0.49, 0.83 and 0.81, respectively. The combined detection of the three indicators had the highest specificity (89.10%) and total effective rate (81.82%). Conclusions AFP and AFP-L3% had good diagnostic value as auxiliary diagnostic indicators on PLC, while GP73 had relatively low diagnostic value. The combined detection of AFP, AFP-L3% and GP73 could improve the specificity of PLC diagnosis and had high clinical value for the diagnosis of PLC.

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