唾液酸化触珠蛋白对乙型肝炎相关肝细胞肝癌的辅助诊断价值

doi:10.3969/j.issn.1673-8640.2020.11.015

摘要/Abstract

摘要：

目的探讨唾液酸化触珠蛋白（Sia-Hp）对乙型肝炎相关肝细胞肝癌（HCC）的辅助诊断价值。方法选取乙型肝炎相关肝硬化患者236例,其中肝硬化伴HCC患者121例（HCC组）、肝硬化不伴HCC患者115例（肝硬化组）,以107名健康体检者作为正常对照组。自建检测血清Sia-Hp水平的凝集素-酶联免疫吸附试验（Lectin-ELISA）方法。采用Spearman等级相关分析评估各项指标之间的相关性。采用受试者工作特征（ROC）曲线评价Sia-Hp、甲胎蛋白（AFP）诊断肝硬化合并HCC的效能。结果 HCC组、正常对照组、肝硬化组血清Sia-Hp水平分别为1.76（1.32~2.22）、1.60（1.17~1.70）、0.85（0.11~1.56）AU/mL,3组之间依次降低（P<0.001）。Spearman等级相关分析结果显示,HCC组和肝硬化组Sia-Hp与AFP无相关性（r=0.09,P>0.05）。在HCC组中,血清Sia-Hp水平与TNM分期有关（P<0.05）,与有无微血管侵犯（MVI）、肿瘤大小无关（P>0.05）。肝硬化组不同Child-pugh分级患者之间血清Sia-Hp水平差异均无统计学意义（P>0.05）。ROC曲线分析结果显示,Sia-Hp、AFP以及二者联合检测模型DIAHCC诊断肝硬化合并HCC的AUC分别为0.83、0.78、0.92,Sia-Hp和联合检测模型DIAHCC诊断AFP阴性（AFP<20 μg/L）患者肝硬化合并HCC的AUC分别为0.84、0.88。结论血清Sia-Hp或可作为肝硬化合并HCC的辅助诊断指标之一。

关键词: 触珠蛋白, 唾液酸, 甲胎蛋白, 肝硬化, 肝细胞癌

Abstract:

Objective To investigate the role of sialylated haptoglobin（Sia-Hp） in the auxiliary diagnosis of hepatitis B-related hepatocellular carcinoma（HCC）. Methods A total of 236 patients with hepatitis B-related cirrhosis were enrolled,and there were 121 patients with liver cirrhosis and HCC（HCC group） and 115 patients with liver cirrhosis without HCC（liver cirrhosis group）. Totally,107 healthy subjects were enrolled as healthy control group. Lectin enzyme-linked immunosorbent assay（Lectin-ELISA） for determining serum Sia-Hp levels was established. Spearman rank correlation analysis was used to evaluate the correlation between various indicators. Receiver operating characteristic（ROC） curve was used to evaluate the efficiency of Sia-Hp and alpha-fetoprotein（AFP） in diagnosing liver cirrhosis with HCC. Results Serum Sia-Hp levels in HCC,healthy control and liver cirrhosis groups were 1.76（1.32-2.22）,1.60（1.17-1.70） and 0.85（0.11-1.56） AU/mL,respectively,which decreased successively among the 3 groups（P<0.001）. Spearman rank correlation analysis showed that there was no correlation between Sia-Hp and AFP in HCC and liver cirrhosis groups（r=0.09,P>0.05）. In HCC group,serum Sia-Hp levels were related to TNM staging（P<0.05）,but were not related to the presence or absence of MVI and tumor size（P>0.05）. There was no statistical significance in serum Sia-Hp levels between patients with different Child-pugh grades in liver cirrhosis group（P>0.05）. ROC curve analysis results showed that the areas under curves（AUC）of Sia-Hp,AFP and the combined determination model DIAHCC for diagnosing liver cirrhosis with HCC were 0.83,0.78 and 0.92,respectively,and the AUC of patients with liver cirrhosis and HCC by Sia-Hp and the combined determination model DIAHCC for diagnosing AFP negative（AFP<20 μg/L） were 0.84 and 0.88,respectively. Conclusions Serum Sia-Hp may be used as one of the auxiliary diagnostic indicators of liver cirrhosis with HCC.

Key words: Haptoglobin, Sialic acid, Alpha-fetoprotein, Liver cirrhosis, Hepatocellular carcinoma

中图分类号:

R521

别立翰, 房萌, 冯惠娟, 陆志成, 高春芳. 唾液酸化触珠蛋白对乙型肝炎相关肝细胞肝癌的辅助诊断价值[J]. 检验医学, 2020, 35(11): 1147-1152.

BIE Lihan, FANG Meng, FENG Huijuan, LU Zhicheng, GAO Chunfang. Role of sialylated haptoglobin for the auxiliary diagnosis of hepatitis B-related hepatocellular carcinoma[J]. Laboratory Medicine, 2020, 35(11): 1147-1152.

图/表 5

表1 HCC组、LC组和正常对照组一般资料的比较 $\ \ \ \ \ \ \ \ $ M（P25~P75）

组别	例数	年龄/岁	TB/（μmol/L）	TP/（g/L）
HCC组	121	54（48~60）	14.00（10.70~17.50）	69.10（66.20~73.50）
肝硬化组	115	54（48~63）	27.00（14.35~46.00）	64.80（60.50~69.60）
正常对照组	107	27（24~41）	11.20（9.00~14.85）	76.20（73.40~79.00）
H值		128.67	96.50	146.47
P值		<0.05	<0.05	<0.05
组别	ALT/（U/L）	WBC计数/（×10⁹/L）	AFP/（μg/L）	CEA/（μg/L）
HCC组	29.00（21.00~44.00）	4.47（3.74~5.46）	25.90（5.60~645.25）	2.50（1.60~3.30）
肝硬化组	23.00（17.00~43.00）	3.38（1.925~4.85）	3.50（1.80~11.20）	2.80（1.90~4.30）
正常对照组	12.00（9.00~20.00）	6.21（5.31~7.22）	2.40（1.60~3.40）	1.50（1.05~2.35）
H值	80.80	98.00	126.81	49.11
P值	<0.05	<0.05	<0.05	<0.05

图1 HCC组、肝硬化组和正常对照组血清Sia-Hp水平的比较

图2 HCC组不同病理特征之间及肝硬化组不同Child-Pugh分级之间血清Sia-Hp水平的比较注：（a）HCC组不同TNM分期之间血清Sia-Hp水平的比较;（b）HCC组有、无MVI之间血清Sia-Hp水平的比较;（c）HCC组不同肿瘤大小之间血清Sia-Hp水平的比较;（d）肝硬化组中不同Child-Pugh分级之间血清Sia-Hp水平的比较

图3 Sia-Hp、AFP和联合检测模型DIAHCC诊断肝硬化合并HCC的ROC曲线注：Sia-Hp; AFP; 联合检测模型DIAHCC; 参考线

图4 Sia-Hp及联合检测模型DIAHCC诊断AFP阴性患者肝硬化合并HCC的ROC曲线注：Sia-Hp; 联合检测模型DIAHCC; 参考线

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