Kang Keun Hee, Kim Ji Hoon, Kang Seong Hee, Lee Beom Jae, Seo Yeon Seok, Yim Hyung Joon, Yeon Jong Eun, Park Jong Jae, Kim Jae Seon, Bak Young Tae, Byun Kwan Soo
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Gut Liver. 2015 Mar;9(2):224-30. doi: 10.5009/gnl14047.
BACKGROUND/AIMS: Prothrombin induced by vitamin K defi-ciency or antagonist II (PIVKA-II) is a widely used diagnostic marker for hepatocellular carcinoma (HCC). We evaluated the correlation between alcoholic liver disease (ALD) and serum PIVKA-II levels in chronic liver disease (CLD) patients.
We retrospectively reviewed the medical records of 2,528 CLD patients without HCC. Among these patients, 76 exhibited serum high PIVKA-II levels of >125 mAU/mL (group 1). We categorized 76 control patients matched by age, sex, and the presence of liver cirrhosis from the remain-ing patients who were negative for serum PIVKA-II (group 2).
Group 1 revealed increased antibiotic usage (23.7% vs 2.6%, p<0.001) and incidence of ALD (60.5% vs 14.5%, p<0.001) as well as elevated aspartate aminotransferase (52.5 IU/L vs 30.5 IU/L, p=0.025) and γ glutamyl transpepti-dase (67.5 IU/L vs 36.5 IU/L, p=0.005) levels compared with group 2. Further, group 1 was significantly associated with a worse Child-Pugh class than group 2. In the multivariate anal-ysis, ALD (odds ratio [OR], 7.151; p<0.001) and antibiotic us-age (OR, 5.846; p<0.001) were significantly associated with positive PIVKA-II levels.
Our study suggests that ALD and antibiotics usage may be confounding factors when interpreting high serum PIVKA-II levels in patients without HCC. Therefore, serum PIVKA-II levels in patients with ALD or in patients administered antibiotics should be interpreted with caution. (Gut Liver, 2015;9224-230).
背景/目的：维生素K缺乏或拮抗剂II诱导的凝血酶原（PIVKA-II）是肝细胞癌（HCC）广泛应用的诊断标志物。我们评估了慢性肝病（CLD）患者中酒精性肝病（ALD）与血清PIVKA-II水平之间的相关性。
我们回顾性分析了2528例无HCC的CLD患者的病历。其中，76例患者血清PIVKA-II水平>125 mAU/mL（第1组）。我们从血清PIVKA-II阴性的其余患者中挑选出76例年龄、性别和肝硬化情况匹配的对照患者（第2组）。
第1组患者的抗生素使用情况（23.7% 对2.6%，p<0.001）、ALD发病率（60.5% 对14.5%，p<0.001）以及天冬氨酸转氨酶水平（52.5 IU/L对30.5 IU/L，p=0.025）和γ-谷氨酰转肽酶水平（67.5 IU/L对36.5 IU/L，p=0.005）均高于第2组。此外，第1组患者的Child-Pugh分级明显比第2组差。多因素分析显示，ALD（比值比[OR]，7.151；p<0.001）和抗生素使用（OR，5.846；p<0.001）与PIVKA-II阳性水平显著相关。
我们的研究表明，在解释无HCC患者的高血清PIVKA-II水平时，ALD和抗生素使用可能是混杂因素。因此，对于ALD患者或使用抗生素的患者，其血清PIVKA-II水平的解读应谨慎。（《胃肠病与肝病学》，2015；9：224 - 230）
