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临床输血与检验

临床输血与检验 ›› 2020, Vol. 22 ›› Issue (4): 429-434.DOI: 10.3969/j.issn.1671-2587.2020.04.022

• 临床检验 • 上一篇    下一篇

外周血CTCs、cfDNA联合检测在肝癌早期筛查中的应用价值分析

阎其均, 翁羽, 朱付英   

  1. 401420 重庆市綦江区人民医院医学检验科
  • 收稿日期:2019-12-05 出版日期:2020-08-20 发布日期:2020-08-12
  • 通讯作者: 朱付英, 女, 主管检验师, 本科, 主要从事临床生化工作, （E-mail）406874622@qq.com。
  • 作者简介:阎其均（1983-）, 女, 重庆人, 主管检验师, 本科, 主要从事临床生化工作, （E-mail）14515817@qq.com。

Application Value of Combined Detection of Peripheral Blood CTCs and cfDNA in Early Screening of Liver Cancer

YAN qi-jun, WENG yu, ZHU Fu-ying   

  1. Clinical laboratory, Qijiang District People's Hospital, Chongqing 401420
  • Received:2019-12-05 Online:2020-08-20 Published:2020-08-12

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摘要： 目的 探讨外周血循环肿瘤细胞（CTCs）、游离DNA（cfDNA）联合检测在肝癌早期筛查中的应用价值。方法 选取我院2017年9月~2019年8月收治的182例高度疑似肝癌患者, 根据病理学检查结果将其分为癌症组和良性组。采用t检验分析两组患者临床指标及外周血CTCs、cfDNA的差异, Pearson相关性分析癌症组患者外周血CTCs、cfDNA水平与肝功能指标、相关肿瘤标志物的关系, 利用受试者工作特征曲线（ROC）评价外周血CTCs、cfDNA检测在早期肝癌筛查中的诊断效能。结果 癌症组患者血清AFP、γ-GT、CEA、ALT、AST、ALP及外周血CTCs、cfDNA水平均高于良性组, 差异均有统计学意义（P<0.05）。经Pearson相关性分析发现, 癌症组外周血CTCs、cfDNA水平与AFP、CEA及肝功能水平均呈正相关性（P<0.05）;肝癌不同分期外周血CTCs、cfDNA水平比较差异具有统计学意义（P<0.05）;ROC曲线显示, CTCs诊断肝癌的AUC为0.854, 最佳临界值为4个/5 mL, 灵敏度为75.54%, 特异性为86.05%;cfDNA诊断肝癌AUC为0.831, 最佳临界值为19.38 ng/mL, 灵敏度为78.42%, 特异性为79.07%;二者联合诊断肝癌的AUC、灵敏度和特异性分别为0.923、82.01%和90.70%。结论 肝癌患者外周血CTCs、cfDNA水平升高, CTCs、cfDNA联合检测对肝癌的早期筛查具有更高的临床价值。

关键词: 循环肿瘤细胞, 游离DNA, 肝癌, 筛查价值

Abstract: Objective To explore theapplicationvalue of combined detection of peripheral blood circulating tumor cells （CTCs） and cell-free DNA （cfDNA） in earlyscreening of liver cancer. Methods From September 2017 to August 2019, a total of one hundred and eighty-twohighly suspected liver cancer patients were enrolled in this study, who were divided into cancer group and benign group according to pathological results.T-testwas used for the difference of clinical data and CTCs/cfDNA. Pearson correlation analysis was employed to analyze the relationship between CTCs, cfDNA levels and liver function indexes and related tumor markers in cancer group. Receiver working characteristic （ROC）curves were used to evaluate diagnostic efficacy of CTCs and cfDNA detection in early liver cancer screening. Results The levels of AFP, γ- GT, CEA, ALT, AST, GGT, ALP and peripheral blood CTCs and cfDNA in cancer group were higher than benign group（P<0.05）.Pearson correlation analysis showed that the levels of CTCs and cfDNA were positively correlated with AFP, CEA and liver function（P<0.05）.There were significant difference between peripheral blood CTCs and cfDNA among different stages of liver cancer（P<0.05）. The ROC analysis showed that AUC of CTCsfor diagnosis of liver cance was 0.854, with cut-off 4 CTCs/5ml, with sensitivity and specificity was 75.54% and 86.05%, respectively; and that AUC of cfDNA was 0.831, with cut-off 19.38ng/ml, with sensitivity and specificity was 78.42% and 79.07%, respectively;butAUC, sensitivity and specificity of both indexsin the diagnosis of liver cancer were 0.923, 82.01% and 90.70%respectively. Conclusion The levels of CTCs and cfDNA in peripheral blood of patients with liver cancer are increased. The combined detection of CTCs and cfDNA has higher clinical value for early screening of liver cancer.

Key words: Circulating, tumor, cells, Cell-free, DNA, Liver, cancer, Screening, value

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