血清PIVKA-Ⅱ在HBV相关肝癌患者中的表达及其与肝功能的相关性

摘要/Abstract

摘要： 目的观察HBV相关肝癌患者血清异常凝血酶原(PIVKA-Ⅱ)表达水平及肝功能指标并分析其相关性。方法 2020年4月—2023年4月解放军联勤保障部队第904医院收治的慢性乙型肝炎患者137例作为慢性乙型肝炎组,另选取同期收治的乙型肝炎肝硬化患者35例作为肝硬化组,同期收治的HBV相关肝癌患者67例作为肝癌组,同期在本院体检健康者51名作为对照组。使用新产业MAGLUMI X8化学发光分析检测血清PIVKA-Ⅱ水平,检测肝功能指标,使用ROCHE cobas6000 E602电化学发光免疫分析仪检测甲胎蛋白(AFP)。以Graphpad prism分析血清PIVKA-Ⅱ水平诊断HBV相关肝癌的价值。结果对照组血清PIVKA-Ⅱ、AFP水平分别为21.0(18.0~27.0)、2.1(1.7~3.3)ng/mL,慢性乙型肝炎组血清PIVKA-Ⅱ、AFP水平分别为22.0(12.0~28.0)、2.3(1.7~3.4)ng/mL,肝硬化组血清PIVKA-Ⅱ、AFP水平分别为21.0(15.0~46.0)、2.5(1.7~4.0)ng/mL,均显著低于肝癌组[PIVKA-Ⅱ、AFP水平分别为61.1(22.0~2021.0)、6.2(2.5~76.8)ng/mL, P<0.05];对照组血清ALT水平为16.0(13.0~26.0)U/L,显著低于慢性乙型肝炎组、肝硬化组、肝癌组[分别为30.0(18.3~44.0)、31.5(20.0~47.3)、30.5(20.0~54.0)U/L, P<0.05];对照组血清AST和GGT水平分别为19.0(16.0~22.0)、24.0(17.0~35.0)U/L,慢性乙型肝炎组血清AST和GGT水平分别为24.0(20.0~31.0)、25.5(17.0~41.7)U/L,均明显低于肝硬化组[分别为31.5(20.0~47.3)、53.5(23.8~99.0)U/L,P<0.05]和肝癌组[分别为31.5(21.5~60.0)、60.0(25.8~135.5)U/L, P<0.05];经Spearman相关性分析,血清PIVKA-Ⅱ与AST、GGT和AFP水平呈正相关(r=0.173, P=0.004; r=0.323,P<0.001; r=0.286, P<0.001);使用Graphpad prism分析,与对照组相较,曲线下面积为0.7523,P<0.05,最佳截断值为41.00 ng/mL,与慢性乙型肝炎组相较,肝癌组PIVKA-Ⅱ曲线下面积为0.7630,最佳截断值为43.50 ng/mL。结论 HBV相关肝癌患者血清PIVKA-Ⅱ水平明显高于慢性乙型肝炎患者和乙型肝炎肝硬化患者,诊断HBV相关肝癌具有较高的灵敏度和具有较高的诊断效能,可作为临床诊断HBV相关肝癌提供一定参考。

关键词: 慢性乙型肝炎, 肝硬化, 肝癌, 异常凝血酶原, 肝功能

Abstract: Objective The abnormal serum PIVKA-II level and liver function in patients with hepatitis B-associated liver cancer were observed and the correlation was analyzed. Methods A total of 137 chronic hepatitis B patients who were enrolled between April 2020 and April 2023 were taken as the chronic hepatitis B group; 35 patients with hepatitis B related cirrhosis admitted during the same period of time were selected as the cirrhosis group; 67 patients with hepatitis B-related liver cancer admitted during the same period of time were selected as the liver cancer group; and 51 healthy subjects who underwent physical examination during the same period of time were selected as the control group. The new industry MAGLUMI X8 chemiluminescence analysis was used to detect the serum PIVKA-Ⅱ level, detect liver function indicators, and ROCHE cobas6000 E602 electrochemiluminescence immunoassay was used to detect alpha fetoprotein (AFP). Graphpad Prism was used to analyze the serum PIVKA-Ⅱ level in the diagnosis of hepatitis B-related liver cancer. Results The levels of serum PIVKA-Ⅱ and AFP were 21.0 (18.0~27.0) and 2.1(1.7~3.3) ng/mL respectively in the control group, 22.0 (12.0~28.0) and 2.3 (1.7~3.4) ng/mL in the chronic hepatitis B group, and 21.0 (15.0~46.0) and 2.5 (1.7~4.0) ng/mL in the cirrhosis group, which were significantly lower than those of 61.1 (22.0~2021.0) and 6.2 (2.5~76.8) ng/mL in the liver cancer group (P<0.05); The serum ALT level in the control group was 16.0 (13.0~26.0)U/L, which was significantly lower than those of 30.0 (18.3~44.0)U/L in the chronic hepatitis B group, 31.5 (20.0~47.3)U/L in cirrhosis group, and 30.5 (20.0~54.0)U/L in liver cancer group [P<0.05]. The serum AST and GGT levels were 19.0 (16.0~22.0) U/L and 24.0 (17.0~35.0) U/L respectively in the control group, 24.0 (20.0~31.0) U/L and 25.5 (17.0~41.7) U/L in the chronic hepatitis B group, which were significantly lower than those of 31.5 (25.0~52.3) U/L, and 53.5 (23.8~99.0) U/L in the cirrhosis group [P<0.05], and 31.5 (21.5~60.0) U/L, and 60.0 (25.8~135.5) U/L in the liver cancer group, [P<0.05]. Spearman correlation analysis showed that serum PIVKA-Ⅱ was positively correlated with AST, GGT and AFP levels (P<0.05) (r=0.173, P=0.004; r=0.323, P<0.001; r=0.286, P<0.001). Using Graphpad prism analysis, compared with the control group, the area under the curve was 0.7523, P<0.05, and the optimal diagnostic cutoff value was 41.00 ng/mL; compared with the chronic hepatitis B group, the area under the curve of PIVKA-Ⅱ was 0.7630, and the optimal diagnostic cutoff value was 43.50 ng/mL. Conclusion The serum PIVKA-Ⅱ level in patients with hepatitis B-related liver cancer is significantly higher than that in patients with hepatitis B and hepatitis B-related cirrhosis, which may have higher diagnostic efficacy for hepatitis B-related liver cancer, and can be used as a reference for clinical diagnosis of hepatitis B-related liver cancer.

Key words: Chronic hepatitis B, Cirrhosis of the liver, Liver cancer, Abnormal prothrombin, Liver function

孔维菊, 任传路, 周昱岐, 李竞争, 何清, 袁俊菲. 血清PIVKA-Ⅱ在HBV相关肝癌患者中的表达及其与肝功能的相关性[J]. 肝脏, 2024, 29(7): 794-797.

KONG Wei-ju, REN Chuan-lu, ZHOU Yu-qi, LI Jing-zheng, HE Qing, YUAN Jun-fei. The correlation between serum PIVKA-II level and liver function in patients with hepatitis B-associated liver cancer[J]. Chinese Hepatolgy, 2024, 29(7): 794-797.

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