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目的 由于维生素K缺乏或拮抗产生的异常蛋白PIVKAⅡ ,又称为γ 羧基凝血素 ,是近年来在日本及美国诊断肝细胞癌 (HCC)的敏感指标 ,但至今仍未用于中国临床 ,本研究的目的是初步评价PIVKAⅡ在中国肝癌患者诊断中的意义。方法 检测 6 0例HCC和 30例排除肝癌的肝硬化患者血清中PIVKAⅡ和甲胎球蛋白 (AFP)水平。结果 在HCC患者中 ,血清PIVKAⅡ的浓度为 (784 3± 136 4 1, x±s)显著高于肝硬化患者 (16 1± 31 7) (P <0 0 0 0 1)。当将PIVKAⅡ的临界值定为 4 0mAU/ml时 ,5 1 7%肝癌患者 (31/ 6 0 )的PIVKAⅡ值高于该临界值 (灵敏度 ) ;但仅 4例肝硬化患者 (13 3%)PIVKAⅡ值高于此临界值。该指标的特异性为 86 7%(2 6 / 30 ) ;精确度为6 2 2 %(31+ 2 6 / 6 0 + 30 ) ;其中 36 84 %的小HCC患者 (7/ 19)的PIVKAⅡ值高于此临界值。在 2 6例AFP阴性的肝癌患者中 ,有 11例 (46 2 %)PIVKAⅡ值高于该临界值 ;肝癌患者的AFP和PIVKAⅡ水平未见显著相关 (rs=0 10 1,P =0 2 4 7)。PIVKAⅡ和AFP联合使用较AFP单独使用灵敏度升高 2 1 6 %,较PIVKAⅡ单独使用灵敏度升高2 6 7%;对小肝癌患者 ,则分别升高 15 8%和 2 1 1%。结论 PIVKAⅡ是肝癌诊断和早期诊断的敏感指标 ,如果与AFP结合使用 ,其
Purpose PIVKAⅡ, also known as γ-curcumin, is a sensitive marker of hepatocellular carcinoma (HCC) diagnosis in Japan and the United States in recent years, but it has not been used in clinical practice in China. The purpose is to evaluate the significance of PIVKAⅡ in the diagnosis of hepatocellular carcinoma in China. Methods The serum levels of PIVKAⅡ and AFP in 60 patients with HCC and 30 patients with cirrhosis excluding hepatocellular carcinoma were detected. Results The serum PIVKAⅡ concentration in patients with HCC was significantly higher than that of patients with liver cirrhosis (784 ± 136 4 1, x ± s) (P <0 0 001). PIVKA II values were higher (sensitivity) in 51.7% of hepatocellular carcinomas (31/60) when the PIVKA II cutoff was 40 mAU / ml; however, only 4 patients (13.3%) had cirrhosis PIVKA II values above this threshold. The specificity of this indicator was 86.7% (26/30); the accuracy was 62% (31 + 26/60); of 3684% of small HCC patients (7/19), PIVKA II Value above this threshold. Eleven patients (46.2%) had PIVKA II values above this threshold in 26 AFP-negative liver cancer patients; AFP and PIVKAⅡ levels were not significantly associated with liver cancer (rs = 0 10 1, P = 0 24 7). The combined use of PIVKAⅡ and AFP was 21.6% higher than that of AFP alone, 26.7% higher than that of PIVKAⅡ alone, and 15.8% and 21.1% of patients with small hepatocellular carcinoma respectively. Conclusion PIVKA Ⅱ is a sensitive indicator of diagnosis and early diagnosis of liver cancer, if used in combination with AFP, its