血清去γ-羧基凝血酶原在肝细胞癌检测中的应用价值。
Usefulness of serum des-gamma-carboxy prothrombin in detection of hepatocellular carcinoma.
作者信息
Wang Chaur-Shine, Lin Chih-Lin, Lee Hsi-Chang, Chen Kuan-Yang, Chiang Ming-Feng, Chen Hung-Sheng, Lin Tsung-Jung, Liao Li-Ying
机构信息
Department of Gastroenterology, Ren-Ai Branch, Taipei City Hospital, No. 10, Sec. 4, Ren-ai Road, Da-an District Taipei City 106, Taiwan, China.
出版信息
World J Gastroenterol. 2005 Oct 21;11(39):6115-9. doi: 10.3748/wjg.v11.i39.6115.
AIM
Des-gamma-carboxy prothrombin (DCP) has been reported to be more sensitive and specific in diagnosing hepatocellular carcinoma (HCC) when compared with alpha-fetoprotein (AFP). However, its ability to identify small HCC still remains unclear. Thus, we conducted a cross-sectional case control study to evaluate whether DCP is better than AFP for differentiating HCC from nonmalignant liver disease and further evaluate the usefulness of DCP in early diagnosis of small HCC.
METHODS
Serum DCP and AFP levels were determined in 127 patients. Among these patients, 32 were with non-cirrhotic chronic hepatitis, 34 were with compensated cirrhosis, and 61 were with HCC. The cut-off value for the DCP and AFP were set as 40 mAU/mL and 20 ng/mL, respectively. To compare the diagnostic value of DCP and AFP in distinguishing HCC from nonmalignant chronic liver disease, receiver operating characteristic (ROC) curves were constructed for each assay.
RESULTS
The accuracy, sensitivity and specificity of DCP were higher than AFP in detecting HCC (81.9%, 77% and 86.4% vs 68.5%, 59% and 77.3%, respectively). The area under the ROC (AUROC) curves revealed that DCP had a better accuracy than AFP in diagnosis of HCC (0.85 [95%CI, 0.78-0.91] vs 0.73 [95%CI, 0.65-0.81], P = 0.013). In 39 patients with solitary HCC, the positive rates of DCP were 100% in patients with tumor size larger than 3 cm, 66.7% in patients with tumor size 2-3 cm and 50% in patients with tumor size less than 2 cm. The positive rates of AFP in patients with tumor size larger than 3 cm, 2-3 cm and less than 2 cm were 55.6%, 50%, and 33.3%, respectively. The median level of DCP in HCC patients with tumor size larger than 3 cm was significantly higher than those with tumor size 2-3 cm and those with the size of less than 2 cm.
CONCLUSION
Our study indicates that DCP has a better diagnostic value than AFP in differentiating HCC from nonmalignant chronic liver disease. DCP has not only a stronger correlation with HCC than AFP in tumor size but also more effectiveness than AFP in detecting small size of HCC.
目的
与甲胎蛋白（AFP）相比，去γ-羧基凝血酶原（DCP）在诊断肝细胞癌（HCC）方面被报道具有更高的敏感性和特异性。然而，其识别小肝癌的能力仍不明确。因此，我们进行了一项横断面病例对照研究，以评估DCP在区分HCC与非恶性肝病方面是否优于AFP，并进一步评估DCP在小肝癌早期诊断中的作用。
方法
测定了127例患者的血清DCP和AFP水平。这些患者中，32例为非肝硬化慢性肝炎患者，34例为代偿期肝硬化患者，61例为HCC患者。DCP和AFP的临界值分别设定为40 mAU/mL和20 ng/mL。为比较DCP和AFP在区分HCC与非恶性慢性肝病中的诊断价值，为每种检测方法构建了受试者操作特征（ROC）曲线。
结果
在检测HCC时，DCP的准确性、敏感性和特异性均高于AFP（分别为81.9%、77%和86.4%，而AFP分别为68.5%、59%和77.3%）。ROC曲线下面积（AUROC）显示，DCP在诊断HCC方面比AFP具有更高的准确性（0.85 [95%CI，0.78 - 0.91] 对比 0.73 [95%CI，0.65 - 0.81]，P = 0.013）。在39例孤立性HCC患者中，肿瘤大小大于3 cm的患者DCP阳性率为100%，肿瘤大小为2 - 3 cm的患者为66.7%，肿瘤大小小于2 cm的患者为50%。肿瘤大小大于3 cm、2 - 3 cm和小于2 cm的患者AFP阳性率分别为55.6%、50%和33.3%。肿瘤大小大于3 cm的HCC患者中DCP的中位数水平显著高于肿瘤大小为2 - 3 cm和小于2 cm的患者。
结论
我们的研究表明，在区分HCC与非恶性慢性肝病方面，DCP比AFP具有更好的诊断价值。DCP不仅在肿瘤大小方面与HCC的相关性比AFP更强，而且在检测小肝癌方面比AFP更有效。
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