薛莎　张露　谢军

[摘要] 目的 探讨血清FER、AFP、AFP-L3联合检测在治疗原发性肝癌的应用价值。 方法 选取2014年1月～2015年12月在运城市中心医院接受治疗的98例原发性肝癌患者、72例良性肝病患者，另选85名健康志愿者作对照组，对其进行血清FER、AFP、AFP-L3检测。 结果 PHC组血清FER检测结果为（818.4±626.5）ug/L，AFP为（546.7±448.2）ug/L，AFP-L3为（109.5±61.3）ug/L，良性肝病组FER检测结果为（123.2±109.3）ug/L，AFP为（2.7±0.9）ug/L，AFP-L3为（7.1±1.9）ug/L，对照组FER检测结果为（234.7±162.2）ug/L，AFP为（5.7±3.8）ug/L，AFP-L3为（25.3±47.2）ug/L，差异均有统计学意义（P<0.05）。PHC组单独检测血清FER的敏感度为74.49%，特异度为81.32%，AFP的敏感度为70.41%，特异度为76.94%，AFP-L3的敏感度为79.27%，特异度为83.50%，对FER、AFP、AFP-L3联合检测结果显示敏感度为92.86%，特异度为86.53%，差异具有统计学意义（P<0.05）；FER、AFP、AFP-L3联合检测时AUC为0.826，高于各指标单项检测，与FER、AFP-L3相比，AUC差异有统计学意义（P<0.05）。 結论 对血清FER、AFP、AFP-L3进行联合检测可以提高原发性肝癌的诊断准确率。

[关键词] 原发性肝癌；敏感度；甲胎蛋白；特异度

[中图分类号] R735.7 [文献标识码] A [文章编号] 2095-0616（2017）15-190-03

[Abstract] Objective To explore the application value of combined detection of serum FER， AFP and AFP-L3 in treatment of primary liver cancer. Methods 98 patients with primary liver cancer and 72 patients with benign liver disease who were treated in Yuncheng Central Hospital from January 2014 to December 2015 were selected.85 healthy volunteers were selected as the control group.Serum FER，AFP and AFP-L3 of them were detected. Results Detection results of serum FER，AFP and AFP-L3 in the PHC group were respectively（818.4±626.5）ug/L，（546.7±448.2）ug/L，and（109.5±61.3）ug/L.Detection results of serum FER，AFP and AFP-L3 in the benign liver disease group were respectively（123.2±109.3）ug/L，（2.7±0.9）ug/L and （7.1±1.9）ug/L.Detection results of serum FER，AFP and AFP-L3 in the control group were respectively（234.7±162.2）ug/L，（5.7±3.8）ug/L and （25.3±47.2）ug/L.Difference were statistically significant（P<0.05）.Sensitivity and specificity of single detection of serum FER in PHC group were respectively 74.49% and 81.32%.Sensitivity and specificity of AFP-A were respectively 70.41% and 76.94%.Sensitivity and specificity of AFP-L3 were respectively 79.27% and 83.50%.Results of combined detection of FER，AFP and AFP-L3 showed that sensitivity and specificity were respectively 92.86% and 86.53%.Difference was statistically significant（P<0.05）.AUC of combined detection of FUC，AFP and AFP-L3 was 0.826，higher than that of single detection of every index.Compared with FER and AFP-L3，difference in AUC had statistical significance（P<0.05）. Conclusion Combined detection of serum FER，AFP and AFP-L3 can improve the accuracy of diagnosis of primary liver cancer.

[Key words] Primary liver cancer；Sensitivity；Alpha-fetoprotein；Specificity

原发性肝癌（PHC）作为世界上致死率最高的恶性肿瘤之一，我国每年因为原发性肝癌死亡的人数约11万人，占世界原发性肝癌的45%左右[1]。原发性肝癌成为仅次于胃癌、食道癌的第三大恶性肿瘤[2-3]。相关研究表明，血清甲胎蛋白（AFP）异常与原发性肝癌有着密切的联系，因此对AFP进行检测使肝癌在亚临床阶段即可做出诊断，早期切除的远期效果尤为显著[4]。血清FER被称为原发性肝癌的第二血清学标志物，可以用于对原发性肝癌的检测，能够有效检测早期肝癌，但单项指标检测的敏感性不高，易造成漏诊[5-6]。为了明确PHC的诊断效果，本研究对PHC患者进行了血清FER、AFP和AFP-L3联合检测，明确各项指标对PHC的诊断价值并分析联合检测的疗效。

1 资料与方法

1.1 一般资料

选取2014年1月～2015年12月在运城中心医院接受治疗的98例原发性肝癌患者、72例良性肝病患者，选取85名健康志愿者作对照组，对其进行血清FER、AFP、AFP-L3检测。其中PHC患者男46例，女52例，年龄24～77岁，平均（47.3±3.4）岁；良性肝病患者男39例，女33例，年龄22～81岁，平均（46.1±3.9）岁；志愿者为健康体检者，男51例，女34例，年龄（25～78）岁，平均（50.1±2.8）岁，身体无疾病，心、肝、肾等器官功能正常，三组比较差异无统计学意义，具有可比性。……