探讨血清甲胎蛋白异质体(AFP-L3)、高尔基体糖蛋白-73(GP73)及甲胎蛋白(AFP)检测在老年人原发性肝癌(HCC)的诊断价值。

研究对象为2014年1月至2016年3月就诊于福建医科大学附属第二医院普外科年龄>60岁的老年患者，共80例；其中HCC组40例，肝良性肿瘤组21例，肝硬化组19例。采用双抗体夹心酶联免疫吸附测定(ELISA)法检测血清GP73水平，电化学发光法检测血清AFP和AFP-L3水平，微量离心柱法分离AFP-L3，并计算甲胎蛋白异质体比例(AFP-L3%)。绘制受试者工作特征曲线(ROC)，分析AFP、AFP-L3、AFP-L3%、GP73单独用于HCC鉴别诊断效果。所有入组患者均签署知情同意书，经医院伦理委员会研究通过。

各组间血清AFP、AFP-L3、AFP-L3%、GP73水平差异有统计学意义(F＝213.04，151.98，231.80，657.04；P<0.01)。HCC组血清AFP、AFP-L3、AFP-L3%、GP73水平[(681.41±195.56)μg/L，(138.11±44.00)μg/L，(15.31±3.28)%，(158.18±14.78)μg/L]高于肝良性肿瘤组[(7.94±3.50)μg/L，(0.41±0.28)μg/L，(3.58±0.51)%，(49.26±8.76)μg/L]，差异具有统计学意义(q＝22.41，22.21，25.18，47.34；P<0.01)；HCC组高于肝硬化组[(64.19±33.59)μg/L，(3.94±2.91)μg/L，(4.23±0.71)%，(46.88±11.64)μg/L]，差异具有统计学意义(q＝25.18，23.56，27.72，47.63；P<0.01)。ROC曲线下面积分别为0.744，0.799，0.720，0.875；GP73曲线下面积最大。AFP诊断HCC敏感度及特异度为62.5%、80.0%，AFP-L3诊断HCC敏感度及特异度为70.0%、77.5%，GP73诊断HCC敏感度及特异度为90.0%、70.0%。AFP与AFP-L3联合检测后敏感度为86.7%，特异度为95.5%；AFP与GP73联合检测后敏感度为96.3%，特异度为95.5%；AFP-L3与GP73联合检测后敏感度为97.0%，特异度为93.3%。

GP73、AFP-L3有望成为新的诊断原发性肝癌的血清标志物，血清AFP-L3、GP73、AFP联合检测联合应用能弥补单项血清标志物的不足，对提高老年HCC的诊断具有一定价值。

To explore the clinical application values of the detection of golgi protein-73(GP73), alpha-fetoprotein variants(AFP-L3), alpha fetoprotein(AFP) in the diagnosis of elderly hepatocellular carcinoma(HCC).

Forty cases of HCC patients(HCC group), 21 cases with benign tumor of liver (benign tumor of liver group)and 19 cases with cirrhotic patients (liver cirrhosis group) were enrolled.GP73 was detected by double antibody sandwich enzyme linked immunosorbent lenscu-linaris (ELISA), AFP and AFP-L3 were examined with electrochemiluminescence immunoassay (ECLIA), AFP-L3 was isolated with agglutinin-coupled spin cloumn(ACSC).

The differences of AFP, AFP-L3, AFP-L3%, GP73 among groups were statistically significant (F=213.04, 151.98, 231.80, 657.04; P<0.01). The expressions of AFP, AFP-L3, AFP-L3% and GP73 of HCC group [(681.41±195.56)μg/L, (138.11±44.00)μg/L, (15.31±3.28)%, (158.18±14.78)μg/L] were higher than those of benign tumor liver group [(7.94±3.50)μg/L, (0.41±0.28)μg/L, (3.58±0.51) %, (49.26±8.76) μg/L], the differences were statistically significant(q=22.41, 22.21, 25.18, 47.34; P<0.01). The expressions of AFP, AFP-L3, AFP-L3% and GP73 of liver cirrhosis group were more obvious [(64.19±33.59) μg/L, (3.94±2.91) μg/L, (4.23±0.71) %, (46.88±11.64) μg/L], compared with HCC group, the differences were statistically significant (q=25.18, 23.56, 27.72, 47.63; P<0.01). However, there were no significant differences of expression between benign tumor of liver group and liver cirrhosis group (q=1.79, 0.513, 1.46, 1.11; P>0.05). The areas of AFP, AFP-L3, AFP-L3% and GP73 under the receiver operating characteristic (ROC) curves in the differential diagnosis of primary hepatic carcinoma (PHC) were 0.744, 0.799, 0.720, 0.875, and the area of GP73 was the largest. The sensitivity and specificity of AFP were 62.5% and 80.0%, AFP-L3 were 70.0% and 77.5%, GP73 were 90.0% and 70.0%.Compared with the single detection, the sensitivity and specificity of AFP and AFP-L3 parallel testing were 86.7% and 95.5%, AFP and GP73 parallel testing were 96.3% and 95.5%, AFP-L3 and GP73 parallel testing were 97.0% and 93.3%.

GP73 and AFP-L3 are expected to become new serum markers for diagnosis of primary liver cancer.The allied combination of serum GP73, AFP-L3 and AFP makes up for the insufficient clinical applications of individual serum makers.