慢性肝炎、肝硬化和肝细胞癌患者的去γ-羧基凝血酶原、甲胎蛋白和甲胎蛋白-L3
Des-gamma-carboxyprothrombin, alpha-fetoprotein and AFP-L3 in patients with chronic hepatitis, cirrhosis and hepatocellular carcinoma.
作者信息
Durazo Francisco A, Blatt Lawrence M, Corey William G, Lin Jiing-Huey, Han Steven, Saab Sammy, Busuttil Ronald W, Tong Myron J
机构信息
The Pfleger Liver Institute, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
出版信息
J Gastroenterol Hepatol. 2008 Oct;23(10):1541-8. doi: 10.1111/j.1440-1746.2008.05395.x. Epub 2008 Apr 19.
BACKGROUND AND AIM
Hepatocellular carcinoma (HCC) is a common complication in patients with chronic viral hepatitis. Detection of HCC at an early stage is critical for a favorable clinical outcome. The study aim was to: (i) compare the levels of des-gamma-carboxyprothrombin (DCP), alpha-fetoprotein (AFP) and AFP-L3 in HCC patients and in chronic viral hepatitis patients without HCC; (ii) define the level of each tumor marker with the best sensitivity and specificity for HCC diagnosis; and (iii) to correlate the levels of these markers with respect to size and tumor burden.
METHODS
Two hundred and forty patients with either hepatitis B virus (HBV) or hepatitis C virus (HCV) infection were studied. These included 144 with HCC, 47 with chronic hepatitis (fibrosis stage I-III on liver biopsy) and 49 with cirrhosis.
RESULTS
Levels of DCP, AFP and AFP L-3 were significantly higher in patients with HCC than in those without HCC (P < or = 0.0001). Receiver-operating curves (ROC) indicated that the cut-off value with the best sensitivity and specificity for each test was > or =84 mAU/mL for DCP, > or =25 ng/mL for AFP and > or =10% for AFP-L3. The sensitivity, specificity and positive predictive value (PPV) for DCP was 87%, 85% and 86.8%, for AFP 69%, 87% and 69.8%, and for AFP-L3 56%, 90% and 56.1%, respectively. DCP levels were below the ROC cut-off in all patients without HCC. In patients with single lesions, there was a direct correlation of DCP to tumor size. High levels of AFP correlated with diffuse type of HCC. All three markers were significantly elevated in the presence of metastatic HCC. No advantage was observed by combining two or three markers for HCC diagnosis.
CONCLUSION
DCP had the highest sensitivity and PPV for HCC diagnosis, had a direct correlation with tumor size, and was not elevated in any patients without HCC. DCP should be used as the main serum test for HCC detection.
背景与目的
肝细胞癌（HCC）是慢性病毒性肝炎患者的常见并发症。早期检测HCC对于良好的临床结局至关重要。本研究的目的是：（i）比较HCC患者与无HCC的慢性病毒性肝炎患者中去γ-羧基凝血酶原（DCP）、甲胎蛋白（AFP）和AFP-L3的水平；（ii）确定对HCC诊断具有最佳敏感性和特异性的每种肿瘤标志物的水平；（iii）将这些标志物的水平与肿瘤大小和肿瘤负荷相关联。
方法
对240例感染乙型肝炎病毒（HBV）或丙型肝炎病毒（HCV）的患者进行了研究。其中包括144例HCC患者、47例慢性肝炎患者（肝活检纤维化分期为I-III期）和49例肝硬化患者。
结果
HCC患者的DCP、AFP和AFP L-3水平显著高于无HCC患者（P≤0.0001）。受试者操作曲线（ROC）表明，每项检测具有最佳敏感性和特异性的临界值分别为：DCP≥84 mAU/mL，AFP≥25 ng/mL，AFP-L3≥10%）。DCP的敏感性、特异性和阳性预测值（PPV）分别为87%、85%和86.8%，AFP分别为69%、87%和69.8%，AFP-L3分别为56%、90%和56.1%。所有无HCC患者的DCP水平均低于ROC临界值。在单发肿瘤患者中，DCP与肿瘤大小呈直接相关。AFP水平高与弥漫型HCC相关。在转移性HCC患者中，所有三种标志物均显著升高。联合两种或三种标志物进行HCC诊断未观察到优势。
结论
DCP对HCC诊断具有最高的敏感性和PPV，与肿瘤大小呈直接相关，且在任何无HCC患者中均未升高。DCP应用作检测HCC的主要血清检测指标。
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