血清可溶性Endogin对肝硬化和肝细胞癌的诊断和鉴别诊
断价值研究
张自然，郭世民，赵和平
【摘 要】【摘 要】目的探讨肝硬化和肝细胞癌（HCC）患者血清可溶性Endogin（sEng）水平差异及其对鉴别诊断的临床意义。方法2009年6月至2014年6月在我院就诊的乙型肝炎肝硬化患者77例、HCC患者54例和健康人36例，采用化学发光法检测血清甲胎蛋白（AFP）水平；采用ELISA法检测血清sEng；sEng与临床指标的相关性检验采用Pearson或Spearman相关分析；采用受试者工作特征曲线下面积（AUC）评价sEng及其联合AFP检测诊断HCC的价值；观察不同sEng水平的HCC患者3 a生存率的差异。结果HCC患者血清sEng水平为19.71（15.16～23.56）ng/L，显著高于肝硬化患者[6.42（4.23～9.89）ng/]L和健康人[2.83（2.28～3.30）ng/L，P<0.05]；HCC患者sEng与AFP水平呈正相关（r=0.660，P＜0.001）；sEng或sEng联合AFP鉴别HCC与健康人的AUC分别为0.912（95%CI：0.851～0.973）和0.951（95%CI：0.911～0.992）；sEng或sEng联合AFP鉴别HCC与肝硬化的AUC分别为0.849（95%CI：0.778～0.920）和0.920（95%CI：0.867～0.972）；高血清sEng水平（≥20.0ng/L）的HCC患者3 a生存率（24.0%）显著低于低血清sEng水平（<20.0 ng/L）者（41.4%，P<0.05）。结论肝硬化与HCC患者血清sEng水平存在差异，可作为HCC患者诊断的参考指标。
【期刊名称】实用肝脏病杂志 【年(卷),期】2016(019)003
【总页数】5
【关键词】【关键词】肝硬化；肝细胞癌；Endogin；甲胎蛋白；诊断 ·肝癌·
[Abstract]Objective
To
investigate
serum
levels
of
soluble
Endogin(sEng)and its clinical significance in the patients with liver cirrhosis and hepatocellular carcinoma(HCC).Methods From June 2009 to June 2014,77 patients with HBV related liver cirrhosis,54 patients with HCC and 36 healthy individuals who had been treated in our hospital were
enrolled
in
this
study.The
serum
levels
of
alpha
fetoprotein(AFP)were assayed by chemiluminescent immunoassay and the serum levels of sEng were detected by enzyme-linked immunosorbent assay.The correlations of sEng and clinical indexes were analyzed by Pearson or Spearman correlation analysis. Furthermore,the diagnostic values of sEng and AFP for HCC were analyzed with ROC curve,and the patients with HCC with different levels of sEng were followed up for three years.Results Serum level of sEng in patients with HCC[19.71(15.16～23.56)ng/L]were significantly higher than that in patients with liver cirrhosis[6.42 ng/L (4.23～9.89)ng/L]or in healthy controls[2.83(2.28～3.30)ng/L,P<0.05];there was a significant positive correlation between serum sEng and serum AFP in patients with HCC(r=0.660,P<0.001);the area under curve(AUC)in discriminating HCC from health control by sEng or sEng with AFP were 0.912(95%CI:0.851～
0.973)and 0.951 (95%CI:0.911～0.992);the AUC in discriminating HCC from cirrhosis by sEng or sEng with AFP were 0.849(95% CI:0.778～0.920)and 0.920(95%CI:0.867～0.972);3 a overall survival rates were24.0%in HCC patients with serum sEng≥20.0 ng/L and 41.4%in HCC patients with serum sEng<20.0 ng/L,respectively(P<0.05).Conclusion The detection of serum sEng can not only improve the diagnosis of HCC,but also has a certain value in prognosis of patients with HCC in clinical practice. [Key
words]Cirrhosis;Hepatocellular
carcinoma;Endoglin;Alpha-
fetoprotein;Diagnosis;Prognosis
乙型肝炎病毒（Hepatitis B virus，HBV）感染在临床上十分常见，是导致肝硬化和肝细胞癌（Hepatocellular carcinoma，HCC）的最重要原因之一。慢性HBV感染患者一旦出现肝硬化，5年内进展为HCC的概率达5%～20%[1]。肝组织活检仍是诊断HCC的金标准，但由于其具有创伤性，且操作者的技术可能影响准确度，无法用于大规模人群的早期筛查。筛查HCC的常规方法仍主要是血清甲胎蛋白（Alpha fetoprotein，AFP）检测及B超检查[2]，但只有约40%～75%HCC患者会出现血清AFP升高，而慢性肝病、妊娠等也可影响AFP诊断的特异性及灵敏度。Endoglin（CD105）是内皮细胞表面的跨膜糖蛋白，参与了调节转化生长因子β（Transforming growth factorβ，TGF-β）信号通路[3]。可溶性Endoglin（Soluble endoglin，sEng）是Endoglin的可溶性蛋白形式，属于抗血管生成因子，参予组织血管新生过程[4]。有研究显示，sEng和TGF-β在肝脏炎症及纤维化时可升高，而炎症和纤维化是导致肝硬化
血清可溶性Endogin对肝硬化和肝细胞癌的诊断和鉴别诊断价值研究
