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目的探讨血清中磷脂酰肌醇蛋白聚糖3(GPC3)和甲胎蛋白异质体(AFP-L3)对低浓度AFP原发性肝细胞癌(PHC)的应用价值。方法收集51例低浓度AFP的PHC患者、52例非肝癌患者和101例健康对照者的血清,分别检测GPC3和AFP-L3,计算敏感度、特异度、准确度和ROC曲线下面积,分析GPC3和AFP-L3与肝癌相关生物学特征的关系。结果低浓度AFP的PHC患者的GPC3和AFP-L3阳性率高于非肝癌患者和健康对照者,差异有统计学意义(P<0.05),而非肝癌组和健康对照组两者无明显差异(P>0.05)。GPC3诊断低浓度AFP PHC患者的敏感度(54.90%)低于AFP-L3(70.59%),差异有统计学意义(P<0.05)。两项联合检测特异度为97.39%,敏感度为86.27%。GPC3和AFP-L3的ROC曲线下面积分别为0.694和0.731。肿瘤直径<5 cm和TMN分期Ⅰ期GPC3和AFP-L3差异无统计学意义(P>0.05)。结论 GPC3和AFP-L3对低浓度AFP PHC患者具有较好的诊断效能,尤其在早期诊断中具有十分重要意义,联合检测能有效避免漏检。
Objective To investigate the value of serum glypican 3 (GPC3) and alpha-fetoprotein (AFP-L3) in the treatment of low-grade AFP primary hepatocellular carcinoma (PHC). Methods Serum samples from 51 PHC patients with low AFP concentration, 52 non-hepatocellular carcinoma patients and 101 healthy controls were collected for detection of GPC3 and AFP-L3. The sensitivity, specificity, accuracy and area under the ROC curve were calculated and analyzed for GPC3 And AFP-L3 and liver cancer-related biological characteristics. Results The positive rate of GPC3 and AFP-L3 in PHC patients with low concentration of AFP was higher than that in non-HCC patients and healthy controls (P <0.05), while there was no significant difference between non-HCC patients and healthy controls P> 0.05). The sensitivity of GPC3 in diagnosing low-concentration AFP PHC patients was 54.90% lower than that of AFP-L3 (70.59%), with statistical significance (P <0.05). The specificity of the two combined tests was 97.39% with a sensitivity of 86.27%. The area under the ROC curve of GPC3 and AFP-L3 were 0.694 and 0.731, respectively. There was no significant difference in the tumor size between the tumor size of 5 cm and stage Ⅰ GPC3 and AFP-L3 (P> 0.05). Conclusion GPC3 and AFP-L3 have good diagnostic efficacy in low-concentration AFP PHC patients, especially in early diagnosis. Combined detection can effectively avoid missed screening.