2022 年第 8 期 第 17 卷

纤维蛋白原样蛋白1对乙型肝炎病毒相关肝细胞癌的诊断价值

Diagnostic value of fibrinogen-like protein 1 in hepatitis B virus-associated hepatocellular carcinoma

作者：蔡馨李欢汤冬玲张平安

英文作者：Cai Xin Li Huan Tang Dongling Zhang Ping′an

单位：武汉大学人民医院检验科，武汉430060

英文单位：Department of Clinical Laboratory Renmin Hospital of Wuhan University Wuhan 430060 China

关键词：肝细胞癌；乙型肝炎病毒；甲胎蛋白；纤维蛋白原样蛋白1

英文关键词：Hepatocellularcellcarcinoma;HepatitisBvirus;Alphafetoprotein;Fibrinogen-likeprotein1 

• 摘要：

• 目的 评估纤维蛋白原样蛋白1(FGL-1)对乙型肝炎病毒（HBV）相关肝细胞癌的诊断价值。方法 研究对象为2019年1—11月招募于武汉大学人民医院肿瘤科、传染科以及体检中心的102例HBV相关肝细胞癌患者（肝细胞癌组）、41例HBV感染后肝硬化患者（肝硬化组）以及48例健康对照者（对照组）。比较各组甲胎蛋白及FGL-1水平，采用受试者工作特征曲线分析FGL-1和甲胎蛋白单独以及联合对肝细胞癌的鉴别诊断价值。结果 肝细胞癌组甲胎蛋白、FGL-1水平均高于对照组和肝硬化组［75.70(7.50,1 907.33)μg/L比3.00(2.20,4.20)、5.20(2.20,11.98)μg/L；46.28(21.83,121.15)μg/L比0.67(0.48,0.91)、21.24(9.85,25.10)μg/L］，差异均有统计学意义(均P＜0.05)。在肝细胞癌组与对照组鉴别诊断时，FGL-1的曲线下面积（AUC）达到1.000，敏感度为99.02%，特异度高达100.00%，此时甲胎蛋白的AUC仅为0.899，且敏感度仅为78.43%，而二者联合的AUC为1.000，敏感度和特异度均为100.00%。在肝细胞癌组与肝硬化组鉴别诊断时，FGL-1的AUC为0.799，高于甲胎蛋白的0.747，且在甲胎蛋白特异度仅有82.93%时，FGL-1的特异度仍保持为100.00%，而二者联合的AUC为0.874，敏感度为71.57%，特异度为100.00%。在肝细胞癌组与对照组+肝硬化组鉴别诊断时，FGL-1的AUC为0.907，此时甲胎蛋白的AUC为0.829，虽然甲胎蛋白敏感度(78.43%)高于FGL-1(65.69%)，但特异度远不及FGL-1(78.65%比98.88%)，而二者联合的AUC为0.942，敏感度为73.53%，特异度为100.00%。结论 FGL-1在诊断HBV相关肝细胞癌时诊断价值强于甲胎蛋白，FGL-1可以作为肝细胞癌的非侵入性诊断指标，且FGL-1与甲胎蛋白联合后诊断效能进一步提升。

• Objective To evaluate the diagnostic value of fibrinogen like protein 1 (FGL-1) in hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC). Methods From January to November 2019, 153 patients and 48 healthy controls recruited from Department of Oncology, Department of Infectious Diseases and Physical Examination Cente, Renmin Hospital of Wuhan University were divided into HBV-associated HCC patients (HCC group, 102 cases), HBV infected cirrhosis patients (cirrhosis group, 41 cases) and healthy controls (control group, 48 cases). The levels of alpha fetoprotein (AFP) and FGL-1 among the groups were compared, and the value of FGL-1 and AFP alone and in combination in the differential diagnosis of HCC was analyzed by receiver operating characteristic curve. Results The levels of AFP and FGL-1 in HCC group were higher than those in control group and cirrhosis group［75.70(7.50,1 907.33)μg/L vs 3.00(2.20,4.20),5.20(2.20,11.98)μg/L；46.28(21.83,121.15)μg/L vs 0.67(0.48,0.91),21.24(9.85,25.10)μg/L］(all P＜0.05). In the differential diagnosis between HCC group and control group, the area under the curve (AUC) of FGL-1 reached 1.000, the sensitivity was 99.02%, and the specificity was 100.00%. At this time, the AUC of AFP was only 0.899, and the sensitivity was only 78.43%, while the combined AUC of the two was 1.000, and the sensitivity and specificity were 100.00%. In the differential diagnosis between HCC group and cirrhosis group, the AUC of FGL-1 was 0.799, which was higher than that of AFP (0.747). The specificity of AFP was only 82.93%, while the specificity of FGL-1 remained 100.00%, and the AUC of the combination of them was 0.874, the sensitivity was 71.57%, and the specificity was 100.00%. In the differential diagnosis between HCC group and control group+cirrhosis group, the AUC of FGL-1 was 0.907 and that of AFP was 0.829. Although the sensitivity of AFP (78.43%) was higher than that of FGL-1 (65.69%), the specificity was far lower than that of FGL-1 (78.65% vs 98.88%). The AUC of the combination of the two was 0.942, the sensitivity was 73.53% and the specificity was 100.00%. Conclusions  The diagnostic value of FGL-1 in the diagnosis of HBV-associated HCC is better than AFP. FGL-1 can be used as a non-invasive diagnostic index of HCC, and the diagnostic efficiency of FGL-1 combined with AFP is further improved.