| Part Ⅰ The diagnostic value of AFP,GPR and GGT/ALT combined detection in HBV-related hepatocellular carcinomaObjective To investigate the diagnostic value of alpha-fetoprotein(AFP),gamma-glutamyltransferase to platelet ratio(GPR)and gamma-glutamyltransferase to alanine aminotransferase ratio(GGT/ALT)in hepatitis B virus(HBV)related hepatocellular carcinoma(HCC),and to provide reference for clinical application.Methods A total of 194 patients with Hepatitis B virus(HBV)infection admitted to First Affiliated Hospital of Soochow University from November 2021 to November 2022 were retrospectively analyzed.According to the degree of disease progression,the patients were divided into hepatitis group(51 cases),liver cirrhosis group(49 cases),and liver cancer group(94 cases).The clinical and laboratory data of all patients were collected,including gender,age,liver function test,blood routine test,imaging and pathological data of patients with Hepatocellular carcinoma(HCC).The patient’s γ-Glutamyl transpeptidase to platelet ratio was denoted as GPR,the γ-glutamyl transpeptidase to platelet ratio was denoted as GPR,and the γ-glutamyl transpeptidase to platelet ratio was denoted as GPR.The ratio of GGT to Alanine aminotransferase(ALT)was recorded as GGT/ALT.Kolmogorov-Smirnov test was used to test the normality of numerical variables,one-way analysis of variance and Kruskal-Wallis test were used to compare the differences among multiple groups,and Mann-Whitney U test was used for pairwise comparison among multiple groups.Spearman correlation analysis was used to compare the correlation between Alpha fetoprotein(AFP),GPR,GGT/ALT and single tumor size.The receiver operating characteristic(ROC)curve was used to compare the diagnostic value of AFP,GPR,GGT/ALT and combined detection in patients with chronic liver disease and HCC patients.Binary logistic regression was used to fit the data for the joint indicators.Ruslts 1.The levels of AFP,GPR and GGT/ALT in HCC group were significantly higher than those in hepatitis group and cirrhosis group,and the differences were statistically significant(P<0.05).The GPR level of the cirrhosis group was higher than that of the hepatitis group,and the difference was statistically significant(P<0.001).There were no significant differences in the levels of AFP and GGT/ALT between the cirrhosis group and the hepatitis group(P>0.05).2.There were significant differences in GPR and GGT/ALT between the single group and the multiple group(P<0.05).The diameter of the single tumor was correlated with GPR and GGT/ALT(rs=0.365,0.385,P<0.01).There was no significant difference in AFP between the single HCC group and the multiple HCC groups(P>0.05).There were no significant differences in AFP,GPR and GGT/ALT between tumors with or without vascular invasion,satellite nodules and different pathological grades(P>0.05).3.The area under the ROC curve of AFP,GPR,GGT/ALT and combined indicators for HCC diagnosis were 0.839[95%CI(0.782,0.897)],0.762[95%CI(0.696,0.828)],0.719[95%CI(0.646,0.791)]and 0.863[95%CI(0.813,0.914)],respectively.The sensitivity and specificity of combined diagnosis were 84%and 77%,respectively.4.1n the non-cirrhotic population,the area under the ROC curve of AFP,GPR,GGT/ALT and combined indicators in the diagnosis of HCC were 0.872[95%CI(0.777,0.966)],0.877[95%CI(0.799,0.955)],0.716[95%CI(0.596,0.836)]and 0.958[95%CI(0.916,1.000)],respectively.The combined index was significantly better than the single index,the sensitivity and specificity were 83.3%and 98%,respectively.Conclusion The combination of AFP,GPR and GGT/ALT can significantly improve the detection rate of HBV-related HCC,especially in non-cirrhotic population with chronic HBV infection.Part Ⅱ Clinical application of N-glycan(G-test)and AFP in populations and patients at risk of HBV associated hepatocellular carcinomaObjective To explore the clinical application of N-glycan(G-test)and alpha-fetoprotein(AFP)in hepatitis B virus(HBV)related related hepatocellular carcinoma risk groups and patients,and to provide reference for clinical diagnosis.Methods A total of 165 patients with chronic HBV infection diagnosed and treated in the First Affiliated Hospital of Soochow University from January 2022 to November 2022 were collected.Among them,42 patients were in the HCC group,and 123 patients with chronic HBV infection in the non-HCC group were further divided into the low-risk group of 40 cases,the medium-risk group of 44 cases,and the high-risk group of 39 cases according to the aMAP score.The clinical and laboratory data of 165 patients with HBV infection were collected.Total bilirubin(TB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(GGT),albumin(ALB),white blood cell(WBC),platelet(PLT),alpha-fetoprotein(AFP),To study the imaging and pathological features of patients with Hepatocellular carcinoma(HCC).Kolmogorov-Smirnov test was used to test the normality of numerical variables.One-way analysis of variance and Kruskal-Wallis test were used to compare the data among the four groups,and Mann-Whitney U test was used for pairwise comparison between groups.ROC curve was used to analyze the efficacy of Alpha fetoprotein(AFP),G-test and combined indicators in the diagnosis of HCC,and binary logistic regression was used to fit the data of the combined indicators.Spearman correlation analysis was used to compare the correlation between laboratory indicators and G-test,and Kappa consistency test was used to analyze the consistency between AFP and G-test results.Results 1.The AFP level in HCC group was significantly higher than that in low,medium and high risk groups(P<0.001),while there was no significant difference in AFP level among low,medium and high risk groups(P>0.05).G-test levels showed a significant upward trend among the low/medium risk group,high risk group,and HCC group(P<0.001),and there was no significant difference in G-test levels between the low risk group and the medium risk group(P>0.05).2.AFP,TB,AST,GGT,FIB-4 were positively correlated with G-test(P<0.001),ALB,WBC,PLT were negatively correlated with G-test(P<0.05).There was no significant correlation between ALT and G-test(P>0.05).3.The consistency analysis of the results of AFP and G-test showed that there were 25 AFP positive cases in 165 subjects,and the positive rate was 15.15%(25/165).The positive rate of G-test was 31.52%(52/165).The consistency rate between AFP and G-test was 80%(132/165),and the consistency was weak(Kappa=0.461,P<0.001).4.The AUC values of AFP and G-test in identifying HBV-related HCC and chronic HBV infection patients was 0.796[95CI(0.706,0.886)]and 0.878[95CI(0.813,0.943)],respectively.When the cut-off values of AFP and G-test were 5.58ng/ml and 5.06,respectively,the optimal sensitivity was 69%and 88.1%,and the specificity was 87%and 87.8%.The AUC values of AFP and G-test in identifying patients with sHCC and chronic HBV infection were 0.717[95CI(0.528,0.907)]and 0.791[95CI(0.659,0.924)],respectively.When the cut-off values of AFP and G-test were 9.50ng/ml and 5.06,respectively,the optimal sensitivity was 50%and 70%,and the specificity was 94.3%and 87.8%.The AUC values of the combined index in the diagnosis of HCC and small hepatocellular carcinoma were 0.901[95CI(0.844,0.957)]and 0.851[95CI(0.771,0.931)],respectively,which were higher than those of the single index,the sensitivity was 90.5%and 80%,and the specificity was both 87.5%.5.The AUC values of G-test in the detection of AFP-negative HCC in the low risk group,medium risk group and high risk group were 0.946[95CI(0.896,0.999)],0.963[95CI(0.922,1.000)]and 0.766[95CI(0.646,0.885)],respectively.The cut-off values were 5.06,5.03 and 5.05,the sensitivity were all 85.7%,and the specificity were 92.5%,97.7%and 71.8%,respectively.Conclusion As a potential serological marker,N-glycan(G-test)has a significantly higher diagnostic efficacy than AFP in patients with HBV-related HCC,and can be used as a supplementary indicator for AFP-negative HCC. |
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