维生素K缺乏诱导蛋白在肝细胞癌检测中的应用价值

Usefulness of determining a protein induced by vitamin K absence in detection of hepatocellular carcinoma.

作者信息

Cui Rutao, Wang Baoen, Ding Huiguo, Shen Hong, Li Yimei, Chen Xiaohong

机构信息

Liver Research Center, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China.

出版信息

Chin Med J (Engl). 2002 Jan;115(1):42-5.

PMID:11930656

Abstract

OBJECTIVE

Protein induced by vitamin K absence or antagonist II (PIVKA II), also called des-gamma carboxy prothrombin (DCP), is a sensitive marker for the diagnosis of hepatocellular carcinoma (HCC), in Japan and the United States since the sensitive kits were available (1998). PIVKA II is not used in clinical diagnosis in China so far. The aim of this study was to assess the diagnostic value of PIVKA II in Chinese patients with HCC.

METHODS

Serum PIVKA II and alpha-fetoprotein (AFP) levels were determined in 60 patients with HCC and 30 patients with cirrhosis not carrying HCC.

RESULTS

The mean serum concentration of PIVKA II in HCC patients (784.3 +/- 1364.1 mean +/- s) was higher than that in cirrhosis patients (16.1 +/- 31.7); this difference was highly significant (P < 0.0001). When the cutoff level of 40 mAU/ml was used as the level of discriminating HCC from cirrhosis, 51.7% of patients (31/60) with HCC had PIVKA II values above this level (sensitivity). Only 4 patients with cirrhosis had such high PIVKA II levels. Thus, the specificity of this test was 86.7% (26/30). Total accuracy was 62.2% [(31 + 26)/(60 + 30)]. Seven of 19 small HCCs (36.84%) had PIVKA II values above the cutoff level. Concentrations of AFP above 20 ng/ml were observed in 34 of 60 patients with HCC (56.7%) and in 11 patients with cirrhosis (36.7%). Eleven of 26 patients with HCC (46.2%) without increased AFP had concentrations of PIVKA II greater than 40 mAU/ml. No significant correlation was found between serum levels of AFP and PIVKA II that were measured in 60 HCC patients (rs = 0.101, P = 0.247). Combining the information from PIVKA II and AFP showed an increase of approximately 21.6% over AFP and 26.7% over PIVKA II alone. For small HCC patients, combining the information from PIVKA II and AFP showed an increase of approximately 15.8% over AFP alone and 21.1% over PIVKA II alone.

CONCLUSION

PIVKA II is a useful early diagnostic marker for HCC and may be more sensitive when combined with AFP in Chinese patients.

摘要

目的

维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II），也称为脱γ羧基凝血酶原（DCP），自1998年有了灵敏检测试剂盒后，在日本和美国成为肝细胞癌（HCC）诊断的敏感标志物。目前在中国，PIVKA-II尚未用于临床诊断。本研究旨在评估PIVKA-II在中国HCC患者中的诊断价值。

方法

测定60例HCC患者和30例未患HCC的肝硬化患者的血清PIVKA-II和甲胎蛋白（AFP）水平。

结果

HCC患者血清PIVKA-II的平均浓度（784.3±1364.1，均值±标准差）高于肝硬化患者（16.1±31.7）；差异具有高度显著性（P<0.0001）。以40 mAU/ml作为区分HCC与肝硬化的临界值时，51.7%（31/60）的HCC患者PIVKA-II值高于此水平（敏感性）。仅有4例肝硬化患者PIVKA-II水平如此之高。因此，该检测的特异性为86.7%（26/30）。总准确率为62.2%[（31+26）/（60+30）]。19例小HCC中有7例（36.84%）PIVKA-II值高于临界值。60例HCC患者中有34例（56.7%）AFP浓度高于20 ng/ml，30例肝硬化患者中有11例（36.7%）AFP浓度高于20 ng/ml。26例AFP未升高的HCC患者中有11例（46.2%）PIVKA-II浓度大于40 mAU/ml。在60例HCC患者中，所测血清AFP水平与PIVKA-II水平之间未发现显著相关性（rs=0.101，P=0.247）。综合PIVKA-II和AFP的信息显示，比单独使用AFP时提高了约21.6%，比单独使用PIVKA-II时提高了26.7%。对于小HCC患者，综合PIVKA-II和AFP的信息显示，比单独使用AFP时提高了约15.8%，比单独使用PIVKA-II时提高了21.1%。