在慢性乙肝患者接受恩替治疗甲胎蛋白是一种肝癌的特异性

StephenW

On-treatment alpha-fetoprotein is a specific tumor marker for hepatocellular carcinoma in patients with chronic hepatitis B receiving entecavir.

Grace Lai-Hung Wong, Henry Lik-Yuen Chan, Yee-Kit Tse, Hoi-Yun Chan, Chi-Hang Tse, Angeline Oi-Shan Lo, Vincent Wai-Sun Wong
Institute of Digestive Disease and The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Hepatology (Impact Factor: 12). 10/2013; DOI:10.1002/hep.26739
Source: PubMed

ABSTRACT Alpha-fetoprotein (AFP) is the most widely used biomarker for hepatocellular carcinoma (HCC) surveillance, which is criticized as neither sensitive nor specific in active hepatitis and liver cirrhosis. The aim of this study was to determine the performance of AFP as a tumor marker for HCC in entecavir-treated patients with chronic hepatitis B (CHB). This was a retrospective-prospective cohort study of 1,531 entecavir-treated patients under regular HCC surveillance with AFP and ultrasonography. The mean age was 52±12 years; 1,099 (72%) patients were male and 332 (21.7%) patients had clinical evidence of cirrhosis. At a mean follow-up of 51±13 months, 57 (2.9%) patients developed HCC of median size of 3.3cm. AFP fluctuated with alanine aminotransferase (ALT) and peaked at the time of starting entecavir, then gradually decreased afterwards. AFP started to increase 6 months before the diagnosis of HCC. The receiver operator characteristic curve (AUROC) of AFP was highest at time of HCC diagnosis (0.85, 95% confidence interval [CI]: 0.73-0.98), and remained satisfactory at 3 months (0.82, 95% CI: 0.73-0.91) and 6 months (0.79, 95% CI: 0.69-0.89) before the diagnosis. Using the conventional AFP cutoff (20 μg/l) at month 0, the sensitivity and specificity to diagnose HCC were 38.6% and 98.9% respectively. Adopting the lower cutoff value (6 μg/l) of AFP level at month 0, the sensitivity was increased to 80.7%, while the specificity was decreased to 80.4%.
On-treatment AFP is a specific tumor marker for HCC in CHB patients receiving entecavir therapy. Adopting a lower cutoff value of AFP level at 6 μg/l would increase the sensitivity significantly for HCC detection. (Hepatology 2013).

StephenW

摘要：甲胎蛋白（ AFP ）是使用最广泛的生物标志物用于肝细胞癌（HCC ）的监控，这是既不敏感，也不具体活动性肝炎和肝硬化的批评。这项研究的目的是确定AFP作为肿瘤标志物恩替卡韦治疗慢性乙型肝炎（ CHB ）患者肝癌的表现。这是一个回顾展1,531恩替卡韦治疗的患者， AFP和超声定期监测HCC的前瞻性队列研究。平均年龄为52 ±12岁; 1,099例患者均为男性（72％）和332 （21.7％）患者有肝硬化的临床证据。在平均随访51 ±13个月， 57例（2.9％）开发的位数3.3厘米大小的肝癌。法新社波动与谷丙转氨酶（ALT）和见顶的时候开始恩替卡韦之后，然后逐渐下降。法新社开始前6个月增加肝癌的诊断。受试者工作特征曲线（ AUROC ）法新社在肝癌诊断的时间（ 0.85， 95％可信区间[CI]为0.73-0.98 ），并在3个月内仍然令人满意（ 0.82， 95 ％ CI ： 0.73-0.91 ）诊断前6个月（0.79 ，95％ CI ： 0.69-0.89 ） 。使用传统的AFP截止（20微克/升） ，在0个月，肝癌诊断的灵敏度和特异性分别为38.6％及98.9 ％ 。采用月0 AFP水平较低的截止值（ 6微克/升） ，灵敏度提高至80.7％ ，而特异性下降至80.4％ 。
对治疗AFP是接受恩替卡韦治疗慢性乙型肝炎患者肝癌的特异性肿瘤标志物。采用AFP水平较低的截止值在6微克/升，会增加肝癌检测的敏感度显着。

疯一点好

看不太明白，到底吃恩替是否有一定危险，斯蒂芬讲一下咯，我正准备换服恩替了。

晓晓111

难道吃恩替卡韦有癌变的可能性吗

StephenW

回复 疯一点好 的帖子

"到底吃恩替是否有一定危险" - 不是!

论文是探讨甲胎蛋白（ AFP ）.

甲胎蛋白（ AFP ）是用于肝细胞癌（HCC ）的监控, 最广泛用的生物标志物，但被批评是既不敏感,又无特异性，在活动性肝炎和肝硬化的患者中.
这项研究的目的是确定AFP作为肿瘤标志物在恩替卡韦治疗慢性乙型肝炎（ CHB ）患者中的表现.
论文结论: 在接受恩替卡韦治疗慢性乙型肝炎患者中, AFP是肝癌的特异性肿瘤标志物.

问题: 在其他抗病毒药物治疗中的患者, AFP 是不是相同的敏感和特异的?

StephenW

回复 晓晓111 的帖子

不是!