范少峰 张辉 赵辉 汪勇 苏华斌

【摘要】 目的：探討异常凝血酶原（PIVKA-Ⅱ）及磷酸酶-张力蛋白同源物基因（PTEN）联合检测对肝细胞癌（HCC）患者5年死亡率的预测价值。方法：回顾性分析2014年1月-2015年1月本院收治并进行肝癌根治术的80例HCC患者的临床资料。将5年内死亡的34例设为死亡组，存活的46例设为存活组。取HCC肿瘤组织，检测入组患者样本中PIVKA-Ⅱ及PTEN表达。比较两组的临床相关资料，多因素logistic回归分析HCC患者5年内死亡的影响因素，ROC曲线分析PIVKA-Ⅱ及PTEN在HCC患者预后评估中的价值;进一步用统计学方法分析PIVKA-Ⅱ与PTEN联合检验对HCC患者预后评估的价值。结果：两组年龄、TNM分期、肿瘤直径比较，差异均无统计学意义（P>0.05）;死亡组患者肿瘤组织中AFP、PIVKA-Ⅱ均明显高于生存组，PTEN含量低于生存组，差异均有统计学意义（P<0.05）。多因素logistic回归模型分析结果显示AFP、PIVKA-Ⅱ、PTEN是HCC患者5年内死亡的影响因素（P<0.05）。ROC曲线分析显示PIVKA-Ⅱ及PTEN联合检测预测HCC患者5年内死亡率的灵敏度和特异度优于单一检测PIVKA-Ⅱ或PTEN。结论：PIVKA-Ⅱ及PTEN联合检测可提高对HCC术后患者5年生存率的预测价值，对临床具有一定的参考价值。

【关键词】 肝细胞癌 磷酸酶-张力蛋白同源物基因 异常凝血酶原 联合检测

Predictive Value of PIVKA-Ⅱ and  PTEN Combined Detection in 5-year Mortality of Patients with Hepatocellular Carcinoma/FAN Shaofeng， ZHANG Hui， ZHAO Hui， WANG Yong， SU Huabin. //Medical Innovation of China， 2021， 18（12）： 0-092

[Abstract] Objective： To investigate the predictive value of abnormal prothrombin （PIVKA-Ⅱ） and phosphatase-tensin homologue gene （PTEN） in 5-year mortality of patients with hepatocellular carcinoma （HCC）. Method： The clinical data of 80 patients with HCC who underwent radical hepatectomy in our hospital from January 2014 to January 2015 were retrospectively analyzed. 34 cases died within 5 years were set as death group and 46 cases survived were set as survival group. The expressions of PIVKA-Ⅱ and PTEN were detected in HCC tissues， the clinical data of two groups were compared， multivariate logistic regression analysis was used to analyze the influencing factors of death in HCC patients within 5 years， ROC curve was used to analyze the prognostic value of PIVKA-Ⅱ and PTEN in HCC patients. The value of PIVKA-Ⅱ combined with PTEN in the prognosis of HCC patients was further analyzed by statistical method. Result： There were no significant differences in age， TNM stage and tumor diameter between two groups （P>0.05）. The levels of AFP and PIVKA-Ⅱ in tumor tissue of death group were significantly higher than those of survival group， and the level of PTEN was lower than that of survival group， the differences were statistically significant （P<0.05）. Multivariate logistic regression model analysis showed that AFP， PIVKA-Ⅱ and PTEN were the influencing factors for the death of HCC patients within 5 years （P<0.05）. ROC curve analysis showed that the sensitivity and specificity of combined detection of PIVKA-Ⅱ and PTEN were better than that of single detection of PIVKA-Ⅱ or PTEN. Conclusion： The combined detection of PIVKA-Ⅱ and PTEN can improve the predictive value of 5-year survival rate of HCC patients， which has a certain reference value for clinical.

[Key words] Hepatocellular carcinoma PTEN PIVKA-Ⅱ Combined detection

First-authors address： Eighth Affiliated Hospital of Guangdong Medical University， Guangzhou 510440， China

doi：10.3969/j.issn.1674-4985.2021.12.021

肝癌多起病隐匿，大多数患者直至出现症状方到医院进行诊疗，错过了治疗的最佳时机，造成患者术后复发率高等不良影响[1]。肝细胞癌（HCC）是原发性肝癌的一种，我国HCC发病例数占原发性肝癌患者整体的90%，占世界HCC总例数的55%，其中大多数患者有乙型肝炎或肝硬化病史[2]。目前，肝细胞癌临床治疗仍以手术和放疗为主，但治疗效果仍不尽人意，有研究显示，部分地区患者术后中位生存时间仅17个月[3]。因此，寻找对HCC患者术后生存率进行精准预测的方法尤为重要。已有研究显示，异常凝血酶原（PIVKA-Ⅱ）与磷酸酶-张力蛋白同源物基因（PTEN）在肝癌的发生及发展中起重要作用[4-5]，其中PIVKA-Ⅱ在肝癌组织中呈高表达，PTEN则呈低表达，有可能对HCC患者术后3年内死亡率进行预测。本研……