联合检测血清肿瘤标志物对肝癌诊断的价值

摘要

Objective To investigate the diagnosticvalue of combined determination of serum tumor markers in patients with primary hepatic carcinoma. Methods The serum concentrations of 8 kinds of tumor markers, including AFP, AFP-L3, CA199, CEA, SF, AFU, GGT and ALP, were detected in 55 hepatoma patients, 120 patients with HBV hepatitis and 30 cases as control group. Using the fourth table method, sensitivity, specificity, Youden index, predict value, likelihood ratio, odd product, accuracy were calculated. Results AFP-L3 of the area under the receiver-operating characteristic curve was the largest, and the specificity, Youden index, odd product, positive likelihood ratio, positive predict value, accuracy of AFP-L3 were the largest, the sensitivity, negative likelihood ratio of GGT were the largest; the parallel test AFP/AFP-L3/CEA in pleural effusion, the sensitivity, negative predict value, Youden index, and the accuracy were 94.6% ,97.2% ,64.6% and 76.6%. the series test AFP + AFP-L3 + GGT in pleural effusion, the specificity, positive likelihood ratio, Youden index,and the accuracy were 97. 3% , 25. 2, 64.6% and 89. 3%. Conclusion Hepatic carcinoma screening test should be first selection AFP/AFP-L3/CEA parallel experiment combination, primary hepatic carcinoma diagnosis should be first selection AFP + AFP-L3 + GGT series test combination.%目的 探讨联合检测血清肿瘤标志物对肝癌诊断的价值.方法 选择55例原发性肝癌( PHC)患者、120例各型肝炎患者和30例正常健康体检者,分别检测血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、糖类抗原( CA199)、癌胚抗原(CEA)、血清铁蛋白(SF)、a-L-岩藻糖苷酶(AFU)、γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)检测,用四格表法计算灵敏度(Se)、特异度(Sp)、Youden指数、预测值(PV)、似然比(LR)、比数积(OP)、准确度(AC)等特征参数.结果 AFP-L3的受试者工作特性曲线下面积最大,其Sp、Youden指数、OP、LR+、PV+、AC也最大,Se、PV-最大为GGT.平行试验中AFP/AFP-L3/CEA组合Se为94.6％,PV-为97.2％,Youden指数为64.6％,AC为76.6％；系列试验中AFP+ AFP-L3+ GGT组合Sp为97.3％,LR+为25.2,Youden指数为64.6％,AC为89.3％.结论 PHC筛查检测应首选AFP/AFP-L3/CEA平行试验组合,确诊检测应首选AFP+AFP-L3+GGT系列试验组合.