摘要
目的探讨AFP在原发性肝癌(HCC)诊断和早期筛查中的最佳阈值。方法收集2007年-2017年于南京医科大学附属淮安第一医院住院、门诊和健康体检确诊的2212例HCC和1998例非HCC患者的临床资料,统计AFP水平。将AFP水平划分为10~20μg/L、21~65μg/L、66~110μg/L、111~155μg/L、156~200μg/L、201~250μg/L、251~300μg/L、301~350μg/L、351~400μg/L、> 400μg/L 10个阈值。比较各阈值、B超以及二者联合诊断HCC的联合敏感度、特异度、阳性似然比、阴性似然比、诊断优势比。构建受试者工作特征曲线(ROC曲线)测定最佳诊断阈值。结果 AFP阈值201~250μg/L组的灵敏度与特异度之和最大(1. 370 1),ROC曲线下面积最大(0. 896 4)。AFP> 20μg/L联合B超诊断肝癌的敏感度最高(95. 35%),诊断优势比为26. 13。结论临床诊断HCC的AFP最佳阈值为200μg/L。应用AFP检测联合B超检查对HCC高危人群进行筛查时,可以将AFP>20μg/L作为阳性指标,结合进一步的鉴别诊断、密切随访和跟踪检查,减少筛查漏诊率。
Objective To investigate the optimal cut - off value of alpha - fetoprotein （ AFP）in the diagnosis and early screening of hepatocellular carcinoma （ HCC） . Methods The clinical data of 2212 HCC patients who were diagnosed and hospitalized in our hospital and 1998non - HCC patients were collected,and the AFP level was summarized. The AFP level was divided into 10 ranges of 10 - 20 μg / L, 21 - 65μg / L,66 - 110 μg / L,111 - 155 μg / L,156 - 200 μg / L,201 - 250 μg / L,251 - 300 μg / L,301 - 350 μg / L,351 - 400 μg / L,and 〉400 μg / L,and a comparative analysis was performed for the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,anddiagnostic odds ratio of each cut - off value of AFP,ultrasound,and their combination in the diagnosis of HCC. The receiver operating characteristic （ ROC）curve was plotted to determine the optimal cut - off value. Results The cut - off valve of AFP of 200 - 250 μg / L had thelargest sum of sensitivity and specificity （ 1. 370 1）and the largest area under the ROC curve （ 0. 896 4） . AFP 〉 20 μg / L combined withultrasound had the highest sensitivity （ 95. 35%）in the diagnosis of HCC,with a diagnostic odds ratio of 26. 13. Conclusion The optimalcut - off value of AFP in the diagnosis of HCC is 200 μg / L. When AFP combined with ultrasound is used for the screening of people at ahigh risk of HCC,AFP 〉 20 μg / L is recommended as a positive index,and its combination with differential diagnosis and close follow - upand examinations can reduce the false negative rate of screening.
作者
田州
张建淮
TIAN Zhou;ZHANG Jianhuai(Nanjing Medical University,Nanjing 210000,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2018年第11期2352-2355,共4页
Journal of Clinical Hepatology
基金
江苏省卫计委面上课题(H201668)
淮安市临床医学科技专项(HAS201411)
关键词
甲胎蛋白类
肝肿瘤
参考值
诊断
普查
alpha - fetoproteins
liver neoplasms
reference values
diagnosis
mass screening
作者简介
田州（1986-）,男,主治医师,主要从事肝脏肿瘤方面的研究.;通信作者：张建淮,电子信箱：15996186060＠qq.com.
