陈宏斌 苏明宽 陈勇 郭建峰 陈琼 吴敏校

[摘要] 目的 探讨联合检测甲胎蛋白（AFP）、甲胎蛋白异质体3（AFP-L3）和α-L-岩藻糖苷酶（AFU）诊断HCC的性能。 方法 选择2017年1月～2018年12月就诊于我院的81例HCC患者为观察组，选择同期就诊于我院的50例良性肝病为良性组，24例健康者为对照组。采集3组空腹静脉血检测AFP、AFP-L3和AFU水平。对比3组AFP、AFP-L3和AFU水平，并分析AFP、AFP-L3和AFU单一检测与联合检测HCC的诊断价值。 结果 观察组AFP、AFP-L3、AFP-L3%和AFU中位水平分别为319.42 ng/mL、49.50 ng/mL、18.65%和46.00 U/L，高于良性组和对照组，差异有统计学意义（P<0.001）;AFP+AFP-L3+AFU检测曲线下面积（AUC）为0.831，高于单一检测AFP（0.761）、AFP-L3（0.828）和AFU（0.685）。 结论 联合检测AFP、AFP-L3和AFU可提高HCC的诊断性能。

[关键词] HCC;甲胎蛋白;甲胎蛋白异质体;α-L-岩藻糖苷酶

[中图分类号] R735.7          [文献标识码] B          [文章编号] 1673-9701（2020）32-0125-04

[Abstract] Objective To explore the efficacy of combined detection of alpha-fetoprotein（AFP）， alpha-fetoprotein heterogene 3（AFP-L3） and α-L-fucosidase（AFU） in the diagnosis of HCC. Methods A total of 81 patients with HCC who were treated in our hospital from January 2017 to December 2018 were selected as the observation group. 50 cases of benign liver disease who were treated in our hospital during the same period were selected as the benign group. 24 healthy people were selected as the control group. Fasting venous blood in the three groups were collected to detect the levels of AFP， AFP-L3 and AFU. The levels of AFP， AFP-L3 and AFU in the three groups were compared and the diagnostic value of single and combined detection of AFP， AFP-L3 and AFU in the diagnosis of HCC was analyzed. Results The median levels of AFP， AFP-L3， AFP-L3% and AFU in the observation group were 319.42 ng/mL， 49.50 ng/mL， 18.65% and 46.00 U/L respectively， which were higher than those in the benign group and the control group， and the differences were statistically significant（P<0.001）; the area under the curve（AUC） of AFP+AFP-L3+AFU detection was 0.831， which was higher than that of AFP（0.761）， AFP-L3（0.828） and AFU（0.685） in the single detection. Conclusion The combined detection of AFP， AFP-L3 and AFU can improve the diagnostic efficacy of HCC.

[Key words] HCC; Alpha-fetoprotein; Alpha-fetoprotein heteroplasm; α-L-fucosidase

肝細胞癌（Hepato cellular carcinoma，HCC）是一种具有病程短、发展迅速、死亡率高等特点的恶性肿瘤。手术切除是临床治疗HCC的主要手段，但仅有1/5的患者有手术切除机会，多数患者因早期无特异性临床表现，就诊时已发展为中晚期，错失最佳治疗时机[1-2]。因此，早期准确鉴别诊断HCC，尽早实施有效的治疗，对提高患者生存率尤为重要。血清肿瘤标志物检测是临床诊断HCC的常用方式，简便易行，甲胎蛋白（Alpha fetal protein，AFP）是早期诊断HCC的传统血清标志物，但在肝硬化、慢性肝炎等良性肝病患者中会不同程度升高，而部分肝癌早期AFP水平不升高，30%～40%患者AFP为阴性[3-5]。甲胎蛋白异质体3（Alpha fetoproteins L3，AFP-L3）是新一代HCC标志物，而α-L-岩藻糖苷酶（α-L-fucosidase，AFU）属于溶酶体酸性水解酶类，也是HCC生物标志物之一。本研究通过联合检测AFP、AFP-L3和AFU评估诊断HCC的性能，旨在为临床诊断HCC提供参考依据，现报道如下。

1 资料与方法

1.1 一般资料

选择2017年12月～2018年12月就诊于我院的81例HCC患者为观察组，其中男54例，女27例;年龄27～80岁。……