| 刘龙,郭潇,赵云龙,等.血清异常凝血酶原和甲胎蛋白在布 -加综合征合并肝细胞癌中的诊断价值[J].安徽医药,2024,28(11):2264-2268. |
| 血清异常凝血酶原和甲胎蛋白在布 -加综合征合并肝细胞癌中的诊断价值 |
| Diagnostic value of PIVKA-Ⅱ and AFP in Budd-Chiari syndrome associated with hepatocellular carcinoma |
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| DOI：10.3969/j.issn.1009-6469.2024.11.031 |
| 中文关键词: 布-加综合征 癌，肝细胞 合并症 异常凝血酶原 甲胎蛋白 倾向性匹配评分 |
| 英文关键词: Budd-Chiari syndrome Carcinoma,hepatocellular Comorbidity Protein induced by vitamin K absence or antagonist-Ⅱ Alpha fetoprotein Propensity score matching |
| 基金项目:江苏省医学重点学科创新团队项目( CXTDA2017028) |
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| 中文摘要: |
| 目的探讨血清异常凝血酶原( PIVKA-Ⅱ)、甲胎蛋白( AFP)在布 -加综合征( BCS)合并肝细胞癌( HCC)中的诊断价值。方法收集 2015年 6月至 2021年 10月徐州医科大学附属医院收治的 43例 BCS合并 HCC病人和 139例单纯 BCS病人临床资料，采用倾向性评分匹配法平衡两组特征差异，匹配后 BCS合并 HCC组 31例、单纯 BCS组53例。比较血清 PIVKA-Ⅱ和 AFP水平对 BCS合并 HCC的诊断效能，分析其与病人病变特征的关系。结果 BCS合并 HCC组血清 PIVKA-Ⅱ［247(77，5 259)AU/L比 17(13，22)AU/L］和 AFP水平［444.20(12.38，5 484.00)μg/L比 3.35(2.16，8.43)μg/L］均显著高于 BCS组(均 P<0.01)。 PIVKA-Ⅱ和 AFP联合检测诊断 BCS合并 HCC的 AUC高于 PIVKA-Ⅱ、AFP单独检测( 0.98比 0.92、0.90)，其中联合检测 AUC较 AFP单独检测差异有统计学意义( P<0.05)。在 BCS合并 HCC病人中，多发 HCC病灶、肿瘤长径之和 ≥5cm、CNLC Ⅲ～Ⅳ期和合并门静脉瘤栓病人的 PIVKA-Ⅱ分别高于单发病灶、肿瘤长径之和 <5 cm、CNLC Ⅰ～Ⅱ期和无门静脉瘤栓的病人(均 P<0.05)；单发病灶病人血清 PIVKA-Ⅱ(r=0.58，P=0.018)和 AFP(r=0.46，P=0.035)阳性水平与肿瘤长径正相关。结论 PIVKA-Ⅱ和 AFP对 BCS合并 HCC均具有较高的诊断价值， PIVKA-Ⅱ联合 AFP可提高诊断效能，且 PIVKA-Ⅱ和 AFP与病人病变特征密切相关。 |
| 英文摘要: |
| Objective To investigate the clinical value of protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ) and alpha fetoprotein (AFP) in the diagnosis of Budd-Chiari syndrome associated with hepatocellular carcinoma.Methods Clinical data of 43 patients with BCS combined with HCC and 139 patients with BCS alone admitted to the Affiliated Hospital of Xuzhou Medical University from June 2015 to October 2021 were collected.The propensity score matching method was used to balance the differences be tween the two groups. After matching, 31 cases of BCS-associated HCC and 53 cases of BCS alone were obtained.The diagnostic efficacy of serum PIVKA-Ⅱ and AFP levels on BCS-combined with HCC was compared, and their relationship with the the lesion characteristics of patients was analyzed.Results The serum PIVKA-Ⅱ[247(77,5 259)AU/L vs. 17(13,22)AU/L] and AFP levels[444.20(12.38,5 484.00)μg/L vs. 3.35(2.16,8.43)μg/L] in the BCS-associated HCC group were significantly higher than those in the BCS group (P<0.01). The AUC of PIVKA-Ⅱ and AFP combined detection for the diagnosis of BCS-combined with HCC was higher than that of PIVKA-Ⅱ and AFP alone (0.98 vs. 0.92,0.90), and the AUC of the combined test was statistically different than that of AFP alone (P<0.05). In patients with BCS combined with HCC, PIVKA-Ⅱ was higher in patients with multiple HCC lesions, sum of tumor diameters≥5 cm, CNLC stages Ⅲ-Ⅳ, and combined with portal vein carcinoma thrombosis than in patients with single lesions, sum of tumor diameters <5cm, CNLC stages Ⅰ-Ⅱ , and no portal vein carcinoma thrombosis, respectively (P<0.05);The positive levels of serum PIVKA-Ⅱ (r= 0.58, P=0.018)and AFP(r=0.46, P=0.035) in patients with single lesions were positively correlated with tumor diameter. Conclusions Both PIVKA-Ⅱ and AFP have high diagnostic value for BCS-associated HCC, PIVKA-Ⅱ combined with AFP can improve the diagnostic efficiency. PIVKA-Ⅱ and AFP are closely related to the lesion characteristics of patients. |
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