| 崔娜,李静,张伟伟.肝细胞癌病人血清异常凝血酶原、周期蛋白依赖性激酶 4水平变化及预后预测价值[J].安徽医药,2025,29(11):2312-2316. |
| 肝细胞癌病人血清异常凝血酶原、周期蛋白依赖性激酶 4水平变化及预后预测价值 |
| Changes in serum PIVKA-Ⅱ and CDK4 levels and their prognostic value in patients with hepatocellular carcinoma |
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| DOI：10.3969/j.issn.1009-6469.2025.11.042 |
| 中文关键词: 癌，肝细胞 肝硬化 乙型肝炎 异常凝血酶原 周期蛋白依赖性激酶 4 |
| 英文关键词: Carcinoma, hepatocellular Cirrhosis Hepatitis B Vitamin K deficiency or antagonist-Ⅱ Cyclin-dependent ki-nase 4 |
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| 中文摘要: |
| 目的探讨肝细胞癌病人血清异常凝血酶原( PIVKA-Ⅱ)、周期蛋白依赖性激酶 4(CDK4)水平变化及预后预测价值。方法选取 2022年 1月至 2023年 6月沧州市第三医院收治的 98例肝细胞癌病人，另选取同期该院 93例肝硬化病人、 87例乙型肝炎病人和 92例体检健康者，比较四组病人血清 PIVKA-Ⅱ、CDK4水平。根据肝细胞癌病人预后情况，分为死亡组( n=31)和存活组( n=67)，分析影响肝细胞癌病人预后因素，并分析血清 PIVKA-Ⅱ、CDK4水平预测肝细胞癌病人死亡的价值。结果肝细胞癌、肝硬化病人、乙型肝炎病人和体检健康者血清 PIVKA-Ⅱ水平分别为( 57.45±6.18)μg/L、(33.72±3.94)μg/L、(29.16±3.68)μg/L、(23.59±3.07)μg/L，CDK4水平分别为( 0.41±0.13)μg/L、(0.32±0.10)μg/L、(0.28±0.09)μg/L、(0.25±0.07)μg/L，各组间比较均差异有统计学意义( P<0.05)肝细胞癌病人血清 PIVKA-Ⅱ、CDK4水平均高于肝硬化、乙型肝炎、体检健康者( P<0.05)；肝硬化病人血清 PIVKA-Ⅱ、CDK4均高于乙型肝炎、体检健康者( P<0.05)；乙型肝炎血清 PIVKA-Ⅱ、CDK4水平均高于体检健康者(P<0.05)；两组病人性别、年龄、分化程度、临床分期、 Child-Pugh分级、血清谷草转氨酶、谷丙转氨酶、总胆红素水平比较均差异无统计学意义( P>0.05)，死亡组肝内淋巴结转移、肝内血管侵犯占比、血清 PIVKA-Ⅱ、CDK4水平均高于存活组( P< 水平，0.05)；肝内血管侵犯、血清 PIVKA-Ⅱ、CDK4水平均是影响肝细胞癌病人死亡的独立危险因素( P<0.05)；血清 PIVKA-Ⅱ、CDK4水平预测肝细胞癌病人死亡的最佳截断值分别为 59.52 μg/L、0.42 μg/L，曲线下面积分别为 0.82、0.85，二者联合的特异度和曲线下面积分别为 97.01%、0.90。结论肝细胞癌病人血清 PIVKA-Ⅱ、CDK4水平均异常升高，二者均可预测肝细胞癌病人死亡，且联合预测准确性更高。 |
| 英文摘要: |
| Objective To explore the changes in serum protein induced by vitamin K deficiency or antagonist-Ⅱ (PIVKA-Ⅱ) and cy-clin-dependent kinase 4 (CDK4) levels and their prognostic value in patients with hepatocellular carcinoma (HCC).Methods A total of 98 patients with hHCC admitted to Cangzhou Third Hospital from January 2022 to June 2023 were selected, along with 93 patientswith liver cirrhosis, 87 patients with hepatitis B, and 92 healthy individuals examined during the same period. Serum levels of PIVKA-Ⅱ and CDK4 were compared among the four groups. The HCC patients were divided into a death group (n=31) and a survival group (n=67) according to the prognosis. Factors influencing the prognosis of HCC patients were analyzed, and the value of serum PIVKA-Ⅱ and CDK4 levels in predicting death in HCC patients was evaluated.Results Serum PIVKA-Ⅱ levels in patients with HCC, liver cirrho-sis, hepatitis B and healthy individuals were (57.45±6.18) μg/L, (33.72±3.94) μg/L, (29.16±3.68) μg/L, and (23.59±3.07) μg/L, respec-tively, while CDK4 levels were (0.41±0.13) μg/L, (0.32±0.10) μg/L, (0.28±0.09) μg/L, and (0.25±0.07) μg/L, respectively. Differencesamong the four groups were statistically significant (P<0.05). Serum PIVKA-Ⅱ and CDK4 levels in HCC patients were higher than those in patients with liver cirrhosis, hepatitis B and healthy individuals (P<0.05). Serum PIVKA-Ⅱ and CDK4 levels in liver cirrhosis patients were higher than those in hepatitis B patients and healthy individuals (P<0.05). Serum PIVKA-Ⅱ and CDK4 levels in hepatitis B patients were higher than those in healthy individuals (P<0.05). There were no statistically significant differences in gender, age, dif-ferentiation degree, clinical stage, Child-Pugh grade, or serum levels of aspartate aminotransferase, alanine aminotransferase and totalbilirubin between the death and survival groups (P>0.05). The proportions of intrahepatic lymph node metastasis and intrahepatic vas-cular invasion, as well as serum PIVKA-Ⅱ and CDK4 levels, were higher in the death group than in the survival group (P<0.05). Intra-hepatic vascular invasion and elevated serum PIVKA-Ⅱ and CDK4 levels were independent risk factors for death in HCC patients (P<0.05). The optimal cut-off values of serum PIVKA-Ⅱ and CDK4 for predicting death in HCC patients were 59.52 μg/L and 0.42 μg/L,with areas under the curve (AUCs) of 0.82 and 0.85, respectively. The combined specificity and AUC for both markers were 97.01%and 0.90, respectively.Conclusions Serum PIVKA-Ⅱ and CDK4 levels are abnormally elevated in HCC patients. Both markers can predict death in HCC patients, and their combined use offers higher predictive accuracy. |
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