河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (6): 665-670.doi: 10.3969/j.issn.1007-3205.2021.06.010

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凝血四项及血清肿瘤标志物联合检测在乙型肝炎相关肝癌中的诊断价值

  

  1. 安徽省宣城市人民医院检验科，安徽 宣城 242000
  • 出版日期:2021-06-25 发布日期:2021-07-05
  • 作者简介:林玲(1983-)，女，安徽宣城人，安徽省宣城市人民医院主管检验师，医学学士，从事临床检验研究。
  • 基金资助:
    宣城市科技计划项目（1813）

Diagnostic value of combined detection of four coagulation indices and serum tumor markers in hepatitis B-related liver cancer

  1. Department of Clinical Laboratory, People′s Hospital of Xuancheng City, Anhui Province， Xuancheng 242000， China
  • Online:2021-06-25 Published:2021-07-05

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摘要： 目的  探讨凝血四项及血清肿瘤标志物联合检测在乙型肝炎相关肝癌中的诊断价值。
方法  选取乙型肝炎相关肝癌（肝癌组）20例、肝硬化（肝硬化组）35例、乙型肝炎（乙型肝炎组）76例为研究对象，收集3组基线资料、乙型肝炎病毒感染相关指标、凝血四项［凝血酶原时间（prothrombin time,PT）、活化部分凝血活酶时间（activated partial thromboplastin time,APTT）、凝血酶时间（thrombin time,TT）、纤维蛋白原（fibrinogen,FIB）］、肝功能［总胆红素（total bilirubin,TBIL）、丙氨酸转氨酶（alanine aminotransferase,ALT）、天冬氨酸转氨酶（aspartate aminotransferase,AST）、碱性磷酸酶（alkaline phosphatase,ALP）、谷氨酰转肽酶（glutamyl transpeptidase,GGT）］及血清肿瘤标志物［甲胎蛋白（α-fetoprotein,AFP）、糖类抗原199（carbohydrate antigen199,CA199）、α-L-岩藻糖苷酶（α-L-fucosidase,AFU）、肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）、血管内皮生长因子（vascular endothelial growth factor,VEGF）］检测结果，以受试者工作特征曲线（receiver operating characteristic curve,ROC）分析凝血四项及血清肿瘤标志物的诊断效能。
结果  肝癌组HBeAg阳性率、HBV-DNA低于肝硬化组、乙型肝炎组，肝硬化组HBV-DNA低于乙型肝炎组，差异有统计学意义（P＜0.05）。肝癌组TBIL、ALT、ALP、GGT高于肝硬化组、乙型肝炎组，AST低于肝硬化组、乙型肝炎组，肝硬化组TBIL、ALT、ALP高于乙型肝炎组，AST低于乙型肝炎组，差异有统计学意义（P＜0.05）。肝癌组PT、APTT、TT短于肝硬化组，长于乙型肝炎组，FIB高于肝硬化组，低于乙型肝炎组，肝硬化组PT、APTT、TT长于乙型肝炎组，FIB低于乙型肝炎组，差异有统计学意义（P＜0.05）。肝癌组血清AFP、CA199、AFU、TNF-α、VEGF水平均高于肝硬化组、乙型肝炎组，肝硬化组血清AFP高于乙型肝炎组，CA199、VEGF水平均低于乙型肝炎组，差异有统计学意义（P＜0.05）。绘制ROC曲线发现，单项检测中，凝血四项、各项血清肿瘤标志物均对乙型肝炎相关肝癌有预测价值（AUC＞0.5），联合检测凝血四项与5种血清肿瘤标志物时敏感度、特异度、准确度最佳，分别为0.83、0.79、0.80，AUC为0.865。
结论  凝血四项与血清肿瘤标志物对乙型肝炎相关肝癌有较好预测价值，值得在临床推广应用。


关键词: 肝肿瘤, 乙型肝炎, 凝血四项, 血清肿瘤标志物

Abstract: Objective  To analyze the diagnostic value of combined detection of four coagulation  indices and serum tumor markers in hepatitis B-related liver cancer. 
Methods  A total of 20 patients with hepatitis B-related liver cancer(liver cancer group), 35 patients with liver cirrhosis(cirrhosis group), and 76 patients with hepatitis B(hepatitis B group) were selected as the research subjects. The baseline data, hepatitis B virus infection-related indicators, detection results of four coagulation indices［prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), fibrinogen(FIB)］, liver function ［total bilirubin(TBIL), alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP), glutamyl transpeptidase(GGT)］, serum tumor markers ［alpha fetoprotein(AFP), carbohydrate antigen 199(CA199), α-L-fucosidase(AFU), thrombin-sensitive protein, tumor necrosis factor-α(TNF-α), vascular endothelial growth factor(VEGF)］ were collected. The receiver operating characteristic curve(ROC) was used to analyze the diagnostic efficiency of four coagulation indices and serum tumor markers. 
Results  The positive rate of HBeAg and HBV-DNA were lower in liver cancer group than in cirrhosis group and hepatitis B group, and lower in cirrhosis group than in hepatitis B group, suggesting significant difference(P＜0.05). TBIL, ALT, ALP and GGT were higher in liver cancer group than in cirrhosis group and hepatitis B group, and higher in cirrhosis group than in hepatitis B group, while AST was lower in liver cancer group than in cirrhosis group and hepatitis B group, and lower in cirrhosis group than in hepatitis B group, with significant difference(P＜0.05). The PT, APTT and TT of liver cancer group were shorter than those of liver cirrhosis group and longer than hepatitis B group. FIB in liver cancer group was higher than that of liver cirrhosis group and lower than that of hepatitis B group. The PT, APTT and TT of liver cirrhosis group were longer, and the FIB was lower, as compared with those of hepatitis B group, suggesting significant difference(P＜0.05). The serum AFP, CA199, AFU, TNF-α, and VEGF levels in liver cancer group were higher than those in cirrhosis group and hepatitis B group; serum AFP in liver cirrhosis group was higher and CA199 and VEGF levels were lower than those in hepatitis B group, with significant difference(P＜0.05). ROC curve analysis showed that four coagulation indices and serum tumor markers alone had predictive value for hepatitis B-related liver cancer(AUC＞0.5). The sensitivity, specificity and accuracy of combined detection of  four coagulation indices and five serum tumor markers were the best, which were 0.83, 0.79 and 0.80 respectively, and AUC was 0.865. 
Conclusion  The four coagulation indices and serum tumor markers have good predictive value for hepatitis B-related liver cancer, which is worthy of clinical promotion and practice.


Key words: liver neoplasms, hepatitis B, four coagulation indices, serum tumor markers

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