原发性肝癌疾病中血清AFP、NGAL与Fbg联合检测的诊断意义研究-现代医学

原发性肝癌疾病中血清AFP、NGAL与Fbg联合检测的诊断意义研究

单位：首都医科大学宣武医院检验科, 北京 100053

分类号：R575

出版年·卷·期（页码）：2019·47·第二期（165-170）

摘要：

目的：探讨原发性肝癌疾病中血清甲胎蛋白（AFP）、中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase associated lipocalin，NGAL）和纤维蛋白原（Fbg）联合检测的诊断意义。方法：选取2016年1月~2017年12月在我院接受治疗的92例原发性肝癌（PLC）患者作为原发性肝癌组研究对象，另选取同期在我院接受治疗的53例乙型肝炎患者（乙肝组）、46例肝硬化患者（肝硬化组）和50例健康体检者（健康组）作为研究对象，采用罗氏E601全自动免疫分析仪检测AFP水平，采用酶联免疫吸附法（ELISA）检测血清NGAL水平，并分别比较各组的血清AFP和NGAL水平，应用SSTA-COMPACT型全自动血凝仪检测并比较各组的血清Fbg水平，分析血清AFP、NGAL、Fbg与PLC临床病例的联系，应用Pearson相关性分析血清AFP、Fbg、NGAL三者之间的相关性，采用受试者工作特征曲线（ROC）判断血清AFP、NGAL、Fbg单独检测和联合检测诊断PLC的敏感度和特异度。结果：PLC组患者血清AFP、NGAL、Fbg水平分别为（683.27±416.54）ng·ml^-1、（32.09±9.04）ng·ml^-1、（5.52±1.38）g·L^-1，均显著高于乙肝组、肝硬化组和健康组（P<0.05），乙肝组的血清AFP也显著高于肝硬化组和健康组（P<0.05），其余指标比较差异则无统计学意义（P>0.05），肝硬化组和健康组血清AFP、NGAL和Fbg水平比较差异均无统计学意义（P>0.05）；PLC组中，随着患者TNM分期的升高，其血清AFP、NGAL和Fbg水平均显著增加，Ⅲ-Ⅳ期患者的血清AFP、NGAL和Fbg水平均显著高于Ⅰ-Ⅱ期者（P<0.05）；相关性分析显示，PLC患者中血清AFP、NGAL和Fbg之间不存在显著相关性（P>0.05）。ROC曲线显示，血清AFP、NGAL和Fbg的曲线下面积（AUC）分别为0.851、0.866和0.819，联合检测血清AFP、NGAL和Fbg的灵敏度可提高至95.3%。结论：PLC患者血清AFP、NGAL和Fbg均显著升高，可作为诊断PLC的血清肿瘤标志物，三者联合检测可显著提高PLC诊断的敏感度，在PLC的诊断和患者预后的评估中具有重要临床价值。

Objective:To investigate the diagnostic significance of combined detection of serum alpha-fetoprotein(AFP), neutrophil gelatinase-associated lipocalin(NGAL)and fibrinogen(Fbg)in primary liver cancer.Methods:A total of 92 patients with primary liver cancer(PLC) who were treated in our hospital from January 2016 to December 2017 were selected as the PLC group. In addition, 53 patients with hepatitis B(the HBV group), 46 patients with liver cirrhosis(the cirrhosis group) and 50 healthy persons(the health group) who were treated in our hospital during the same period were selected as study subjects. The serum AFP level and the serum NGAL level were detected by Roche E601 automatic analyzer and enzyme-linked immunosorbent assay(ELISA), respectively. The levels of serum AFP and NGAL in each group were compared. The serum Fbg levels in each group detected by using the SSTA-COMPACT automatic coagulometer were compared. The relationship between serum AFP, NGAL, Fbg and PLC clinical cases was analyzed. Pearson correlation analysis was used to analyze the correlation between serum AFP, Fbg and NGAL. The receiver operating characteristic curve(ROC) was used to determine the sensitivity and specificity of serum AFP, NGAL, Fbg detection and combined detection for diagnosis of PLC.Results:The serum levels of AFP, NGAL and Fbg in the PLC group were(683.27±416.54) ng·ml^-1,(32.09±9.04) ng·ml^-1 and(5.52±1.38) g·L^-1, respectively, which were significantly higher than those in the HBV group, the cirrhosis group and the health group(P<0.05). The serum AFP in the HBV group was also significantly higher than that in the cirrhosis group and the health group(P<0.05), and there was no significant difference in other indicators(P>0.05). There was no significant difference in serum levels of AFP, NGAL and Fbg between the cirrhosis group and the health group(P>0.05). In the PLC group, the serum AFP, NGAL and Fbg levels increased significantly with the increase of patients' TNM stage. The serum AFP, NGAL and Fbg levels in patients with stage Ⅲ-Ⅳ were significantly higher than those in stage I-Ⅱ(P<0.05). The correlation analysis showed that there was no significant correlation between serum AFP, NGAL and Fbg in PLC patients(P>0.05). The ROC curve showed that the area under the curve(AUC) of serum AFP, NGAL, and Fbg was 0.851, 0.866 and 0.819, respectively. The sensitivity of combined detection of serum AFP, NGAL and Fbg increased to 95.3%. Conclusion:The serum AFP, NGAL and Fbg levels in PLC patients are significantly elevated and can be used as diagnostic tumor markers for PLC. Combined detection of these three factors can significantly increase the sensitivity of PLC diagnosis, which has an important clinical value in the diagnosis of PLC and evaluation of patient prognosis.

参考文献：

[1] 王剑,董伟,刘福晨,等.《原发性肝癌诊疗规范(2017年版)》更新要点解读[J].第二军医大学学报,2017,38(9):1085-1091.
[2] 李波,李伯安.自身抗体检测在原发性肝癌诊断中的意义[J].中华检验医学杂志,2016,39(2):76-78.
[3] 袁星星,姜菲菲,贾泳梅,等.血清铁蛋白和甲胎蛋白及甲胎蛋白异质体-L3单项与联合检测对原发性肝癌辅助诊断的临床应用价值[J].中华检验医学杂志,2016,39(8):604-608.
[4] 林建姣,刘艳,胡红松,等.胃癌患者血清中性粒细胞明胶酶相关载脂蛋白水平及临床意义[J].胃肠病学和肝病学杂志,2016,25(6):642-645.
[5] 黑子清,甘小亮,罗刚健,等.重型肝炎和肝癌病人肝移植术中凝血功能的变化[J].临床麻醉学杂志,2006,22(5):321-323.
[6] 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].传染病信息,2017,16(3):705-720.
[7] MINAGAWA M,IKAI I,MATSUYAMA Y,et al.Staging of hepatocellular carcinoma:assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan[J].Ann Surg,2007,245(6):909-909.
[8] 中华医学会肝病学分会中华医学会感染病学分会.慢性乙型肝炎防治指南2010年更新版[J].中华实验和临床感染病杂志:电子版,2011,5(1):50-60.
[9] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.酒精性肝病诊疗指南(2010年修订版)[J].中华肝脏病杂志,2010,18(3):167-170.
[10] 李瑜元,脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病诊疗指南(2006年2月修订)[J].现代消化及介入诊疗,2007,12(4):266-268.
[11] ZHU M,WEI L,YAN L,et al.HBx drives alpha fetoprotein expression to promote initiation of liver cancer stem cells through activating PI3K/AKT signal pathway[J].Int J Cancer,2017,140(6):1346-1346.
[12] TINHOLT M,SANDSET P M,IVENSEN N.Polymorphisms of the coagulation system and risk of cancer[J].ThrombRes,2016,140(7):49-54.
[13] 魏容,梁艳丽,王明霞,等.原发性肝癌患者治疗后血清AFP、NLR、PLT及部分凝血指标的变化[J].贵阳医学院学报,2017,42(11):1297-1301.
[14] 高丹,景三辉,吴歌.血清Cys C和NGAL及U-mAlb/Cr在恶性肿瘤患者化疗肾损害早期诊断中的价值[J].肿瘤基础与临床,2017,30(3):189-191.
[15] EILENBERG W,STOJKOVIC S,PIECHOTAPOLANCZYKA,et al.Neutrophil gelatinase-associated lipocalin(ngal) is associated with symptomatic arotid atherosclerosis and drives pro-inflammatory state in vitro[J].Eur J Vasc Endovasc Surg,2016,51(5):623-631.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录