人异常凝血酶原(PIVKA-II)在监测结直肠癌肝转移中的应用

doi:10.6040/j.issn.1671-7554.0.2018.1019

摘要/Abstract

摘要： 目的探讨人异常凝血酶原即维生素K缺乏或拮抗剂II诱导的蛋白(PIVKA-II)在监测结直肠癌肝转移中的应用价值。方法采集治疗前结直肠癌患者120例(结直肠癌无器官转移组80例和结直肠癌肝转移组40例)、早期肝癌患者(早期肝癌组)80例和查体健康人群(健康组)80例血清样本,检测其PIVKA-II和癌胚抗原(CEA)浓度,确定PIVKA-II监测结直肠癌肝转移的临界值,分析PIVKA-II和CEA对监测结直肠癌肝转移的诊断效能。结果健康组、结直肠癌无器官转移组、结直肠癌肝转移组和早期肝癌组的血清PIVKA-II浓度依次呈增高趋势,分别为18(15~20.8)mAU/mL、20(17~24)mAU/mL、32(22.3~41.8)mAU/mL和345(31.8~3 787)mAU/mL,结直肠癌肝转移组显著高于健康组(P<0.001)和结直肠癌无器官转移组(P<0.001),低于早期肝癌组(P<0.001)。血清PIVKA-II检测结直肠癌肝转移的曲线下面积(AUC)为0.818(95%CI:0.736~0.901),与CEA的AUC差异无统计学意义［0.799(95%CI:0.710~0.888),Z=0.332,P=0.74］。PIVKA-II检测结直肠癌肝转移的最佳临界值为28.5 mAU/mL,此时灵敏度为60%,特异度为90%。联合PIVKA-II和CEA,结直肠癌患者肝转移的检测灵敏度提高到85%。结论血清PIVKA-II可用于结直肠癌肝转移的监测。

关键词: 人异常凝血酶原, 癌胚抗原, 结直肠癌, 肝转移, 诊断

Abstract: Objective To evaluate the diagnostic value of serum prothrombin induced by vitamin K absence or antagonist-II(PIVKA-II)in patients with liver metastasis of colorectal cancer(CRC). Methods A total of 120 CRC patients(including 80 without organ metastasis and 40 with liver metastasis), 80 patients with early-stage hepatocellular carcinoma(HCC)and 80 healthy controls were involved in the study. The levels of serum PIVKA-II and carcinoembryonic antigen(CEA)were determined to evaluate the optimal cut-off values. The diagnostic sensitivity and specificity of PIVKA-II and CEA for the liver metastasis of CRC were analyzed. Results The median concentrations of serum PIVKA-II in healthy controls, CRC patients without organ metastasis, CRC patients with liver metastasis and early-stage HCC patients were 18(15-20.8)mAU/mL, 20(17-24)mAU/mL, 32(22.3-41.8)mAU/mL and 345(31.8-3 787)mAU/mL, respectively. The median PIVKA-II level was significantly greater in CRC patients with liver metastasis 山东大学学报 (医学版)56卷10期 -朱宇,等.人异常凝血酶原(PIVKA-II)在监测结直肠癌肝转移中的应用 \=-than that in healthy controls (P<0.001)and CRC patients without organ metastasis(P<0.001), but significantly lower than that in early-stage HCC patients(P<0.001). There was no significant difference between PIVKA-II and CEA in the area under the receiver operating characteristic curve(AUC)［0.818(95%CI: 0.736-0.901)vs 0.799(95%CI: 0.710-0.888), Z=0.332, P=0.74］. The optimal cut-off value of PIVKA-II for the detection of CRC liver metastasis was 28.5 mAU/mL, with sensitivity of 60% and specificity of 90%. A combination of PIVKA-II and CEA increased the sensitivity(85%)in detecting CRC liver metastasis. Conclusion PIVKA-II could serve as a marker for CRC liver metastasis screening.

Key words: Prothrombin induced by vitamin k absence or antagonist-II, Carcinoembryonic antigen, Colorectal cancer, Liver metastasis, Diagnosis

中图分类号:

R735.3

朱宇,王宏洁,韩彬彬,冯莎娜,张春,李学祥,韩晓红,崔巍. 人异常凝血酶原(PIVKA-II)在监测结直肠癌肝转移中的应用[J]. 山东大学学报 (医学版), 2018, 56(10): 58-63.

ZHU Yu, WANG Hongjie, HAN Binbin, FENG Shana, ZHANG Chun, LI Xuexiang, HAN Xiaohong, CUI Wei. A study of serum PIVKA-II in patients with liver metastasis of colorectal cancer[J]. Journal of Shandong University (Health Sciences), 2018, 56(10): 58-63.

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