维生素 K 拮抗剂 II 诱导蛋白、甲胎蛋白和γ-谷氨酰转移酶/天冬氨酸氨基转移酶比值对移植候选者肝细胞癌的诊断预测价值。

Predictive value of protein induced by absence of vitamin K absence or antagonist II, alpha-fetoprotein and gamma-glutamyltransferase/aspartate aminotransferase ratio for the diagnosis of hepatocellular carcinoma in transplantation candidates.

机构信息

Department of Gastroenterology, Gazi University School of Medicine, Ankara.

Department of General Surgery, Ordu University School of Medicine, Ordu.

出版信息

Eur J Gastroenterol Hepatol. 2021 Feb 1;32(2):294-299. doi: 10.1097/MEG.0000000000001884.

DOI:10.1097/MEG.0000000000001884

PMID:32796360

Abstract

OBJECTIVES

Alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) are used as tumour markers for the diagnosis of hepatocellular carcinoma (HCC). We investigate whether combined liver function marker such as gamma-glutamyl transferase (GGT) and aspartate aminotransferase (AST) with alpha-fetoprotein (AFP) and PIVKA-II increase their diagnostic predictive value in diagnosis of HCC.

METHODS

The serum levels of PIVKA-II, AFP and GGT/AST ratio were analysed in 112 transplant candidates. Of these patients, 66 (59%) had HCC and 46 (41%) patients did not.

RESULTS

Histological grade was positively correlated with serum levels of PIVKA-II and AFP (r = 0.255, P < 0.039 and r = 0.284, P < 0.021, respectively) and only tumour size positively correlated with the serum level of PIVKA-II (r = 0.270, P < 0.028), but no correlation between the number of tumour, Milan criteria and PIVKA-II (r = -0.002, P = 0.984 and r = 0.154, P = 0.216, respectively) with AFP (r = -0.024, P = 0.851 and r = 0.080, P = 0.522, respectively). Sensitivity and specificity of AFP, PIVKA-II and GGT/AST ratio at cutoff values of 6.08, 2.63 and 0.89, respectively, were as follows: 77, 77 vs 71, 83 vs 60 and 53%. The combination of AFP and PIVKA-II and GGT/AST ratio in HCC diagnosis increased AUROC values as follows; 0.860 vs 0.882 and 0.823 vs 0.840, respectively.

CONCLUSIONS

This study showed that combined tumour markers such as AFP, PIVKA-II and GGT/AST ratio increase their sensitivity in HCC diagnosis.

摘要

目的

甲胎蛋白（AFP）和维生素 K 缺乏或拮抗剂-II 诱导蛋白（PIVKA-II）被用作肝细胞癌（HCC）诊断的肿瘤标志物。我们研究了联合肝功能标志物如谷氨酰转移酶（GGT）和天门冬氨酸氨基转移酶（AST）与甲胎蛋白（AFP）和 PIVKA-II 是否会增加它们在 HCC 诊断中的诊断预测价值。

方法

分析了 112 名移植候选者的 PIVKA-II、AFP 和 GGT/AST 比值的血清水平。其中，66 例（59%）患有 HCC，46 例（41%）患者没有。

结果

组织学分级与 PIVKA-II 和 AFP 的血清水平呈正相关（r=0.255，P<0.039 和 r=0.284，P<0.021），仅肿瘤大小与 PIVKA-II 的血清水平呈正相关（r=0.270，P<0.028），但肿瘤数量、米兰标准与 PIVKA-II 之间无相关性（r=-0.002，P=0.984 和 r=0.154，P=0.216）与 AFP（r=-0.024，P=0.851 和 r=0.080，P=0.522）。AFP、PIVKA-II 和 GGT/AST 比值的截断值分别为 6.08、2.63 和 0.89，其敏感性和特异性分别为 77、77 与 71、83 与 60、53%。AFP 和 PIVKA-II 与 GGT/AST 比值联合用于 HCC 诊断时，AUROC 值分别增加至 0.860 与 0.882 和 0.823 与 0.840。