本文選題：PIVKA-II　切入點：癌　出處：《青島大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:研究與探討血清異常凝血酶原(PIVKA-II)和甲胎蛋白(AFP)在原發(fā)性肝癌(HCC)中的診斷和療效監(jiān)測中的臨床應(yīng)用價值。方法:病例對照研究。用化學(xué)發(fā)光法和電化學(xué)發(fā)光法檢測2013年8月至2014年3月期間青島大學(xué)附屬醫(yī)院148例肝細(xì)胞癌、37例肝內(nèi)膽管細(xì)胞癌、44例胃、結(jié)直腸癌、63例肝硬化、38例慢性乙型肝炎、57例體檢健康者血清PIVKA-II和AFP水平,分別分析兩者單獨及聯(lián)合檢測診斷HCC的受試者工作曲線下面積(ROC-AUC)、敏感度和特異性;分析血清PIVKA-II和AFP水平與腫瘤直徑大小及TNM分期的相關(guān)性;比較HCC患者治療前后兩指標(biāo)血清水平的變化。結(jié)果:肝細(xì)胞癌組血清PIVKA-II和AFP水平均高于肝內(nèi)膽管細(xì)胞癌組、胃結(jié)直腸癌組、肝硬化組、慢性乙型肝炎組和健康對照組(PIVKA-II:U值分別為866.50、424.00、958.00、292.00和448.00;AFP:U值分別為713.00、440.50、1182.00、614.00和399.00,P均0.001)。兩指標(biāo)單獨檢測和聯(lián)合檢測對HCC組患者的ROC-AUC均無顯著性差異(P0.05)。PIVKA-II診斷HCC的敏感度(87.16%)高于AFP(68.92%,χ2=4.73,P0.05),PIVKA-II和AFP聯(lián)合檢測診斷HCC的敏感度(93.24%)高于PIVKA-II單項檢測(87.16%,校正χ2=64.70,P0.01),但特異度之間比較均無統(tǒng)計學(xué)差異(P0.05)。Spearman秩相關(guān)分析顯示,血清PIVKA-II和AFP水平與腫瘤大小均呈正相關(guān)(相關(guān)系數(shù)分別為0.716和0.475,P均0.001)。隨腫瘤直徑增大,HCC患者PIVKA-II和AFP水平逐漸升高(H值分別為72.70、37.02,P均0.001);陽性率也逐漸提高(χ2值分別為26.74、21.62,P均0.01)。按國際腫瘤TNM分期,Ⅰ~Ⅳ期血清PIVKA-II和AFP水平(H值分別為46.63、21.38,P均0.001)與陽性率(PIVKA-II:χ2=20.40,P0.01;AFP:χ2=8.33,P0.05)也隨TNM腫瘤分期的增高而升高。HCC患者治療后血清PIVKA-II和AFP水平均低于治療前(Z值分別為-4.59、-4.22,P均0.001),不同TNM分期患者治療后PIVKA-II(Z值分別為-2.85、-2.98、-2.70,P均0.05)和AFP水平均分別低于同期治療前水平(Z值分別為-2.48、-3.82、-2.50,P均0.05)。結(jié)論:血清PIVKA-II和AFP在HCC診斷和療效監(jiān)測等方面均具有較高的臨床應(yīng)用價值,用于診斷HCC時,PIVKA-II的敏感度明顯高于AFP,兩指標(biāo)聯(lián)合檢測可提高單獨檢測的敏感度,且不降低其診斷特異度。
[Abstract]:Objective: to study and evaluate the clinical value of serum prothrombin prothrombin (PIVKA-II) and alpha-fetoprotein (AFP) in the diagnosis and efficacy monitoring of primary hepatocellular carcinoma (HCC). Methods: a case-control study. Chemiluminescence and electrochemiluminescence were used. Methods from August 2013 to March 2014, 148 patients with hepatocellular carcinoma (HCC) and 44 patients with intrahepatic cholangiocarcinoma were examined in Qingdao University affiliated Hospital. The serum levels of PIVKA-II and AFP in 38 patients with chronic hepatitis B and 57 healthy controls were analyzed in 63 patients with colorectal cancer and 38 patients with chronic hepatitis B. The sensitivity and specificity of the two methods under the operating curve for the diagnosis of HCC were analyzed. The relationship between serum PIVKA-II and AFP levels and tumor diameter and TNM staging was analyzed, and the changes of serum PIVKA-II and AFP levels in patients with HCC before and after treatment were compared. Results: the levels of serum PIVKA-II and AFP in HCC group were higher than those in intrahepatic cholangiocarcinoma group. Gastric colorectal cancer group, liver cirrhosis group, The values of PIVKA-IIU in chronic hepatitis B group and healthy control group were 866.50 ~ 424.00 ~ 958.00 ~ 292.00 and 448.00 ~ 48.00 ~ 292.00 and 448.00 = 713.00 ~ 440.50 ~ 1182.00 ~ 614.00 and 399.00% respectively respectively. There was no significant difference between the two indexes in the diagnosis of ROC-AUC in HCC group (P 0.05). PIVKA-II was 87.16) higher than AFP 68.92%, 24.73% P 0.05% PIVKA-II and AFP (蠂 ~ 2 蠂 ~ (2)) were higher than that in AFP group (P = 68.92), respectively. There was no significant difference between the two indexes in the diagnosis of HCC by P0.05. PIVKA-II) and the sensitivity of PIVKA-II was 87.16% higher than that of AFP 68.92%. The sensitivity of the combined detection in the diagnosis of HCC was higher than that in the single test of PIVKA-II (87.16). The correction of 蠂 2 + 64.70% P0.01D was significant, but there was no significant difference in the specificity between the two groups (P 0.05N. Spearman rank correlation analysis). The serum levels of PIVKA-II and AFP were positively correlated with tumor size (correlation coefficients were 0.716 and 0.475g / kg, respectively). With the increase of tumor diameter, PIVKA-II and AFP levels increased gradually, and the H values were 72.70 and 37.02, respectively, and the positive rates were also gradually increased (蠂 2 were respectively). 26.74-21.62P and 0.01g / L respectively. According to the international TNM stage of tumor, Serum PIVKA-II and AFP levels in stage 鈪，

本文編號：1588936