| Objective:1.To analyze the expression differences of serum tumor markers AFP,AFP-L3,and GP73 in hepatitis,liver cirrhosis,and liver cancer,and influence factors related to the expression level of each serological tumor marker.2.To analyze the value of AFP?AFP-L 3 ?GP73 alone or jointly in the diagnosis of hepatocellular carcinoma(HCC).3.Detection of GP73 in liver cirrhosis and its significance in liver cirrhosis and primary hepatocellular carcinoma.Methods:We enrolled 112 cases of patients diagnosed with hepatocellular carcinoma for the first time,who had lived in The First Hospital of Jilin University during January 2016 to December 2017.At the same time,49 patients with hepatitis and 90 patients with cirrhosis in our hospital were randomly recruited.We collected the patients' data,such as gender,age,laboratory tests and imaging examination.we conducted a case-control study and the statistics were analyzed by the spss22.0 software.Results:1.The expression level of AFP was the highest in HCC group(p<0.05).There was significant difference in AFP-L3 expression between hepatitis group,cirrhosis group and liver cancer group(p<0.05).The expression level of GP73 was the highest in cirrhotic patients(p<0.05).We further subdivided the liver cirrhosis group into the compensated liver cirrhosis group and decompensated liver cirrhosis group.And the HCC group was further divided into the early HCC group and advanced HCC group.We found that the expression levels of AFP and AFP-L3 were the highest in advanced HCC group and was significantly higher than early HCC group,decompensated liver cirrhotic group and compensated liver cirrhotic group.The expression level of GP73 in decompensated liver cirrhosis group was highest and was significantly higher than the other three groups and the difference was statistically significant(p<0.05).2.There was a correlation between AFP and BCLC stage,and the expression level of AFP increased gradually from BCLC 0 to C stage;the expression level of AFP-L3 in different BCLC stages was different(p<0.05);but there was no correlation between GP73 and BCLC stage.The expression levels of AFP and AFP-L3 were correlated with portal hypertension and portal vein tumor thrombus,while GP73 was associated with cirrhosis-related complications,such as hepatic encephalopathy,spontaneous peritonitis,portal hypertension,ascites,esophagogastric varices anemia,splenomegaly,hypoproteinemia,and the differences were statistically significant(p<0.05).There was no correlation between AFP and Child-pugh class of liver function,the same is true of AFP-L3.The expression level of GP73 was increased gradually from class A to C in Child-pugh class(p<0.05).3.The recommended cut-off points for AFP,AFP-L3,GP73 are 20ng/ml,10% and 150ng/ml respectively.The positive rates of AFP and AFP-L3 in HCC group were higher than those in cirrhosis group and hepatitis group,and the positive rate of AFP in HCC group was higher than that in AFP-L3 group,but the positive rate of GP73 in cirrhosis group was higher than that in liver cancer group and hepatitis group.In the HCC group,32 cases of AFP<7ng/ml,18 cases of 7ng/ml<AFP<20ng/ml,43 cases of 20ng/ml<AFP<400ng/ml,19 cases of AFP>400ng/ml.When AFP<7ng/ml,0 cases of AFP-L3 positive,6 cases of GP73 positive(6/36,18.8%);when 7ng/ml?AFP<20ng/ml,2 cases of AFP-L3 positive(2/18,11.1%),11 cases of GP73 positive(11/18,61.1%);when 20 ng/ml?AFP<400ng/ml,15 cases of AFP-L3 positive(15/43,34.9%),24 cases of GP73 positive(24/43),55.8%);when AFP?400ng/ml,14 cases of AFP-L3 positive(14/19,73.7%),7 cases of GP73 positive(7/19,36.8%).Since AFP-L3 is typically not detected for AFP<7ng/ml,AFP-L3% was not relevant for the diagnosis of HCC for individuals with a total AFP<7ng/ml.And the positive rate of AFP-L3 is the highest when AFP>400ng/ml.By using the area under the ROC curve,we compared the efficacy of AFP,AFP-L3,GP73 alone or combined in the diagnosis of HCC in patients with cirrhosis.We found that there was no statistical difference in the area under the curve,that is,the increase of the detection index did not improve the efficiency of HCC diagnosis.The sensitivity of AFP-L3 combined detection with AFP,AFP-L3,GP73 in the diagnosis of HCC is similar to that of AFP-L3,GP73.The sensitivity of AFP?AFP-L3 combined detection to diagnose HCC is similar to that of AFP,AFP-L3,GP73 combined detection.(64.3%VS65.2%).The specificity of AFP-L3 in the diagnosis of HCC was higher than that in AFP-L3,GP73 combined detection of HCC(88.9% VS80.0%).Conclusion:1.Both AFP and AFP-L3 can diagnose HCC effectively.AFP-L3 is more specific than AFP,so it is more advantageous to diagnose HCC.2.The level of GP73 expression is associated with the severity of liver cirrhosis,which can be considered for the severity of cirrhosis and the dynamic monitoring of chronic liver disease,but it is not recommended for the diagnosis of HCC.3.The combined detection of AFP and AFP-L3 has high sensitivity to diagnose HCC.It is considered that HCC can be detected and diagnosed early by combining the two methods. |
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