Itoshima T, Kawaguchi K, Ukida M, Ito T, Hattori S, Kitadai M, Ogawa H, Mizutani S, Kita K, Tanaka R
Acta Med Okayama. 1984 Apr;38(2):159-68. doi: 10.18926/AMO/30328.
Sex, age and 21 routine liver function assays were analyzed by stepwise selection and the best-of-all-possible-combinations method to identify a small group of assays valuable in establishing which liver cirrhosis (LC) patients have a high risk of hepatocellular carcinoma (HCC), when alpha-fetoprotein (AFP) is not elevated. Data was obtained from 115 HCC and 122 LC patients on admission. Tumor size correlated with AFP (0.73), alkaline phosphatase (ALP, 0.47), leucine aminopeptidase (LAP, 0.42), lactic dehydrogenase (LDH, 0.42), and the glutamic oxaloacetic transaminase (GOT)/glutamic pyruvic transaminase (GPT) ratio (GOT/GPT, 0.41). The mean of the correct diagnosis rates (CDR) of HCC and LC utilizing AFP as the sole parameter (89%) was markedly higher than those of the other parameters. The best-of-all-possible-combinations method presented a more powerful combination than stepwise selection. The best combination of 7 parameters (LAP, GOT/GPT, choline esterase, one-hour erythrocyte sedimentation rate, age, albumin/globulin ratio, and total bilirubin) presented a mean CDR of 80%, HCC CDR of 77%, and false positive rate of 18%. LC patients statistically diagnosed as having HCC by these 7 parameters are proposed as high risk patients. Fourteen (78%) of 18 HCC patients who were AFP-negative were statistically diagnosed. This analysis can be applied to LC patients to distinguish those that should be followed closely by imaging diagnostic techniques.
通过逐步选择和所有可能组合中的最佳组合方法，对性别、年龄和21项常规肝功能检测进行分析，以确定一小部分在甲胎蛋白（AFP）未升高时，对判断哪些肝硬化（LC）患者有肝细胞癌（HCC）高风险有价值的检测项目。数据来自115例HCC患者和122例LC患者入院时的情况。肿瘤大小与AFP（0.73）、碱性磷酸酶（ALP，0.47）、亮氨酸氨基肽酶（LAP，0.42）、乳酸脱氢酶（LDH，0.42）以及谷草转氨酶（GOT）/谷丙转氨酶（GPT）比值（GOT/GPT，0.41）相关。以AFP作为唯一参数时，HCC和LC的正确诊断率（CDR）均值（89%）明显高于其他参数。所有可能组合中的最佳组合方法比逐步选择法呈现出更强有力的组合。7个参数（LAP、GOT/GPT、胆碱酯酶、一小时红细胞沉降率、年龄、白蛋白/球蛋白比值和总胆红素）的最佳组合呈现出的CDR均值为80%，HCC的CDR为77%，假阳性率为18%。通过这7个参数被统计学诊断为HCC的LC患者被提议作为高风险患者。18例AFP阴性的HCC患者中有14例（78%）被统计学诊断。该分析可应用于LC患者，以区分那些应通过影像诊断技术密切随访的患者。
