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目的探讨高尔基体蛋白73(GP73)与甲胎蛋白异质体(AFP-L3)联合检测在乙型肝炎病毒相关性肝癌诊断中的价值。方法收集132例血清,其中原发性肝癌(PHC)56例、肝硬化33例,慢乙肝患者23例,健康对照20例,酶联免疫吸附法(ELISA)检测各组GP73的表达情况;应用甲胎蛋白异质体亲和吸附离心管洗脱获得AFP-L3,同时化学发光法检测原始血清中总AFP和AFP-L3,计算AFP-L3在总AFP中的比率。结果 PHC组、肝硬化组、肝炎组及健康对照组血清GP73水平分别为247.05(228.35～287.72)、176.83(159.51～183.98)、152.58(135.19～162.85)、43.00(37.96～52.64)ng/mL,AFP-L3%分别为14.52(12.33～15.28)%、5.68(4.32～7.74)%、4.31(3.57～6.45)%、3.29(2.60～4.25)%。PHC组GP73和AFP-L3%均明显高于其他组(P均<0.01);GP73和AFP-L3%用于诊断PHC的ROC曲线下面积分别为0.825、0.828,最佳截取值分别为187.60 ng/mL、9.98%,此时的敏感度分别为69.6%、64.3%,特异度分别为86.8%、96.1%。二者联合诊断PHC的敏感度为82.1%,特异度为85.5%。结论 GP73和AFP-L3%均可作为诊断PHC的血清标记物,二者联合检测具有更高的灵敏度,可提高PHC的诊断率。
Objective To investigate the value of combined detection of GP73 and AFP-L3 in the diagnosis of hepatitis B virus-associated liver cancer. Methods Serum was collected from 132 patients, including 56 cases of primary hepatocellular carcinoma (PHC), 33 cases of cirrhosis, 23 cases of chronic hepatitis B, 20 healthy controls and the expression of GP73 in each group by enzyme-linked immunosorbent assay (ELISA) AFP-L3 was eluted by affinity chromatography on α-fetoprotein heterogeneous body. The total AFP and AFP-L3 in the original serum were detected by chemiluminescence, and the ratio of AFP-L3 in total AFP was calculated. Results The serum levels of GP73 in PHC group, cirrhosis group, hepatitis group and healthy control group were 247.05 (228.35 ~ 287.72), 176.83 (159.51 ~ 183.98), 152.58 (135.19 ~ 162.85), 43.00 (37.96 ~ 52.64) ng / AFP-L3% were 14.52 (12.33 ~ 15.28)%, 5.68 (4.32 ~ 7.74)%, 4.31 (3.57 ~ 6.45)% and 3.29 (2.60 ~ 4.25)%, respectively. The area under the ROC curve of GP73 and AFP-L3% for diagnosis of PHC were 0.825 and 0.828 respectively, and the best cut-off values were 187.60 ng / mL, 9.98%. The sensitivity at this time were 69.6%, 64.3%, and the specificity was 86.8%, 96.1% respectively. The sensitivity of the combined diagnosis of PHC was 82.1% and the specificity was 85.5%. Conclusion Both GP73 and AFP-L3% can be used as serum markers for the diagnosis of PHC. The combined detection of GP73 and AFP-L3% has higher sensitivity and can improve the diagnosis rate of PHC.