血清AFP-IgM复合物联合肝功能检测对原发性肝癌的评价

Evaluation of hepatocellular carcinoma by combined detection of serum AFP-IgM complex and liver function

摘要:

目的：分析新型的肝癌诊断标志物甲胎蛋白-免疫球蛋白M（Alpha-fetoprotein-immunoglobulin M，AFP-IgM）复合物联合肝功能检测对原发性肝癌（Hepatocellular carcinoma，HCC）的诊断意义。方法：收集HCC患者血清64例、肝硬化患者血清27例，用酶联免疫吸附法与电化学发光法分别检测血清AFP-IgM复合物和甲胎蛋白（Alpha-fetoprotein，AFP）含量，并收集临床肝功能检测数据。结果：应用接受者操作特性（Receiver operating characteristic，ROC）曲线确定AFP-IgM的最佳切割值为300 AU/ml。在此切割值下，肿瘤直径≤3 cm的患者血清AFP-IgM浓度（1 195.4±561.8） AU/ml明显高于肿瘤直径>3 cm者（584.3±771.7） AU/ml。且AFP-IgM浓度与临床分期比较，Ⅰ~Ⅱ期的HCC患者血清中的AFP-IgM浓度（1 033.0±508.0） AU/ml高于Ⅲ~Ⅳ期HCC患者（569.2±791.7） AU/ml，其差异有统计学意义（P<0.01）。应用ROC曲线确定?酌-谷氨酰转移酶（Gamma-glutamyl transpeptidase，GGT）的最佳切割值为GGT≥154 U/L。在此切割值下，GGT对HCC诊断的敏感度为73.4%，特异度为55.6%。联合GGT与AFP-IgM对HCC诊断，其敏感度为46.9%，特异度为70.3%，有效率为53.8%。结论：AFP-IgM检测有助于提高原发性小肝癌诊断的有效性和早期HCC的筛检与确诊。AFP-IgM联合肝功能检测在临床上有助于鉴别诊断HCC和肝硬化，并有望成为早期小肝癌的筛检方法之一。

Abstract:

Objective：To analyze the value of the combined detection of a new hepatocellular carcinoma（HCC） marker，alpha-feto－protein immunoglobulin M（AFP-IgM） complex and liver function in diagnosing HCC. Methods：The serum from 64 cases of HCC and 27 cases of liver cirrhosis was collected. ELISA and electrochemiluminescence were employed in the detection of AFP-IgM complex and AFP respectively. The clinical data of patients’ liver function were collected. Results：According to the receiver operating char－acteristic（ROC） curve，the best cut-off value of AFP-IgM immune complex was 300 AU/ml. At this best cut-off value，the serum AFP-IgM complex was significantly higher in the patients with tumor diameter ≤3 cm than in the patients with tumor diameter >3 cm（（1 195.4±561.8） AU/ml vs. （584.3±771.7） AU/ml）. The serum AFP-IgM complex in patients at Ⅰ-Ⅱ clinic stages was higher than that in patients at Ⅲ-Ⅳ clinic stages（（1 033.0±508.0） AU/ml vs. （569.2±791.7） AU/ml）（P<0.01）. According to ROC curve，the best cut-off value of gamma-glutamyl transpeptidase（GGT） was ≥154 U/L. The sensitivity of GGT in the diagnosis of HCC was 73.4%，with specificity of 55.6%，and the sensitivity of combined AFP-IgM and GGT in the diagnosis of HCC was 46.9%，with specificity of primary 70.3% and effective rate of 53.8%. Conclusions：AFP-IgM detection helps to improve the effectiveness in the diagnosis of small hepatocellular carcinoma and HCC at early stage. AFP-IgM combined liver function tests can help to do differential diagnosis of liver cirrhosis and HCC，which is expected to become screening method for small hepatocellular carcino－ma at early stage.