血清甲胎蛋白检测早期肝细胞癌的性能受抗病毒治疗和血清

StephenW

血清甲胎蛋白检测早期肝细胞癌的性能受抗病毒治疗和血清天冬氨酸氨基转移酶的影响：一项大型乙型肝炎病毒感染患者队列研究
钱向军 1 2 , 刘艳娜 1 , 吴凤萍 3 , 张思雨 4 , 焦功 5 , 南岳敏 4 , 伯虎 5 , 陈俊辉 6 , 赵景敏 7 , 陈向美 1 , 潘卫东 2 , 双锁 3 , 冯敏陆 1 8 9
隶属关系
隶属关系

    1
    北京大学医学部基础医学院传染病中心微生物学系,北京 100191
    2
    中山大学附属第六医院胰肝胆外科，广州 510655
    3
    西安交通大学第二附属医院感染科,西安 710004
    4
    河北医科大学第三医院中西医结合肝病科,石家庄 050051
    5
    中山大学第三附属医院检验科，广州 510630
    6
    北京大学深圳医院介入与细胞治疗中心，深圳 518035
    7
    中国人民解放军总医院第五医学中心病理肝病科，北京 100039
    8
    郑州大学医学科学院精准医学中心,郑州 450001
    9
    北京大学人民医院,北京大学肝病研究所,丙型肝炎与肝病免疫治疗北京市重点实验室,北京 100044

    PMID：36016291 PMCID：PMC9416230 DOI：10.3390/v14081669

免费 PMC 文章
抽象的

背景和目的：乙型肝炎病毒 (HBV) 感染患者中与异常升高的甲胎蛋白 (AFP) 相关的因素仍有待研究。我们旨在确定与非肝细胞癌 (HCC) 和早期 HCC 患者血清 AFP 升高相关的因素及其对 AFP 检测早期 HCC 性能的影响。

方法：这项多中心、回顾性研究对 4401 名慢性 HBV 感染患者进行，其中包括 3680 名非 HCC 患者和 721 名早期 HCC 患者。分析了与 AFP 升高相关的因素。通过受试者工作特征曲线下面积（AUC）、敏感性和特异性在各组之间比较 AFP 对早期 HCC 的诊断性能。

结果：当通过多变量逻辑回归分析时，抗病毒治疗与 AFP 升高呈负相关，而乙型肝炎 e 抗原 (HBeAg) 和天冬氨酸氨基转移酶 (AST) >在非 HCC 和早期 HCC 患者中，1 倍正常上限 (ULN) 与升高的 AFP 呈正相关（所有 p < 0.05）。与非抗病毒治疗相比，抗病毒治疗、HBV DNA（-）、丙氨酸氨基转移酶（ALT）≤1×ULN、AST≤1×ULN的AFP检测早期HCC的AUC显着升高， HBV DNA (+), ALT > 1×ULN 和 AST > 1×ULN 组，分别。将患者分类为 AST ≤ 1× ULN 和 >无论抗病毒治疗如何，AFP 在 AST ≤ 1× ULN 的患者中达到最高的 AUC（AUC 分别为 0.813 和 0.806）。此外，当应用相似的敏感性和特异性时，不同亚组中 AFP 检测早期 HCC 的临界值存在相当大的差异。

结论：抗病毒治疗和血清AST可用于帮助判断和选择不同高危人群HCC监测血清AFP的具体临界值。

关键词：甲胎蛋白；抗病毒治疗；天冬氨酸氨基转移酶；乙型肝炎病毒;肝细胞癌。
利益冲突声明

作者宣称没有利益冲突。

StephenW

The Performance of Serum Alpha-Fetoprotein for Detecting Early-Stage Hepatocellular Carcinoma Is Influenced by Antiviral Therapy and Serum Aspartate Aminotransferase: A Study in a Large Cohort of Hepatitis B Virus-Infected Patients
Xiangjun Qian  1   2 , Yanna Liu  1 , Fengping Wu  3 , Siyu Zhang  4 , Jiao Gong  5 , Yuemin Nan  4 , Bo Hu  5 , Junhui Chen  6 , Jingmin Zhao  7 , Xiangmei Chen  1 , Weidong Pan  2 , Shuangsuo Dang  3 , Fengmin Lu  1   8   9
Affiliations
Affiliations

    1
    Department of Microbiology, Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China.
    2
    Department of Pancreatic Hepatobiliary Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510655, China.
    3
    Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
    4
    Department of Traditional and Western Medical Hepatology, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
    5
    Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
    6
    Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen 518035, China.
    7
    Department of Pathology and Hepatology, The 5th Medical Centre, Chinese PLA General Hospital, Beijing 100039, China.
    8
    Precision Medicine Center, Academy of Medical Sciences, Zhengzhou University, Zhengzhou 450001, China.
    9
    Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing 100044, China.

    PMID: 36016291 PMCID: PMC9416230 DOI: 10.3390/v14081669

Free PMC article
Abstract

Background and aims: Factors associated with abnormally elevated alpha-fetoprotein (AFP) in hepatitis B virus (HBV)-infected patients remain to be studied. We aimed to identify factors associated with elevated serum AFP in patients with non-hepatocellular carcinoma (HCC) and early-stage HCC and their influences on the performance of AFP for detecting early-stage HCC.

Methods: This multicenter, retrospective study was conducted in 4401 patients with chronic HBV infection, including 3680 patients with non-HCC and 721 patients with early-stage HCC. Factors associated with elevated AFP were analyzed. Diagnostic performance of AFP for early-stage HCC were compared among groups through area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.

Results: When analyzed by multivariate logistic regression, antiviral therapy was negatively associated with elevated AFP, while hepatitis B e antigen (HBeAg) and aspartate aminotransferase (AST) &gt; 1× upper limit of normal (ULN) were positively associated with elevated AFP both in patients with non-HCC and early-stage HCC (all p &lt; 0.05). The AUCs of AFP for detecting early-stage HCC in patients with antiviral therapy, HBV DNA (-), alanine aminotransferase (ALT) ≤ 1× ULN, and AST ≤ 1× ULN were significantly higher compared to those in non-antiviral therapy, HBV DNA (+), ALT &gt; 1× ULN, and AST &gt; 1× ULN groups, respectively. When categorizing patients into AST ≤ 1× ULN and &gt; 1× ULN, AFP achieved the highest AUCs in patients with AST ≤ 1× ULN regardless of antiviral treatment (AUCs = 0.813 and 0.806, respectively). Furthermore, there were considerable differences in the cut-off values of AFP in detecting early-stage HCC in different subgroups when applying similar sensitivity and specificity.

Conclusions: Antiviral therapy and serum AST might be used to help judge and select the specific cut-off values of serum AFP for HCC surveillance in different at-risk populations.

Keywords: alpha-fetoprotein; antiviral therapy; aspartate aminotransferase; hepatitis B virus; hepatocellular carcinoma.
Conflict of interest statement

The authors declare no conflict of interest.

StephenW

https://www.mdpi.com/1999-4915/14/8/1669/pdf?version=1659069558