glypican3适配子对肝癌诊断价值的分析 word格式.docxVIP

摘 要诊断价值，最佳单指标诊断肝癌与非肝癌的 AUROC 为 0.75 左右，多指标联合检测为 0.9 左右。2 个适配子联合分析诊断肝癌与非肝癌的 AUROC、敏感 度、特异度、准确度均达 0.9 以上，优于单一适配子。在 55 例小肝癌（≤3cm）中，两个适配子的检测阳性率分别为 63.6%和 49.1%，高于 AFP（43.6%）；两者联合分析阳性率进一步提高，达 74.5%。在68 例 AFP 阴性肝癌，两个适配子的检测阳性率分别为 70.6%和 69.1%，两者 联合分析达 83.8%。3．ELISA 检测血清 GPC3 对肝癌的诊断价值：肝癌组的血清 GPC3 水平 为 1.22±3.07ng/mL，肝硬化组的血清 GPC3 水平为 1.36±3.35ng/mL，两组间 差异无统计学意义，诊断肝癌的 AUROC 为 0.575。4．肿瘤标志物对肝癌的诊断价值：在 4 组血清标本中，只有 AFP 对肝 癌具有一定的诊断价值，诊断肝癌与非肝癌的 AUROC 为 0.761，其他肿瘤标 志物（CEA、CA125、CA199）无明显诊断价值，4 种肿瘤标志物联合诊断肝 癌的 AUROC 无明显增加。结论：1．GPC3 适配子对肝癌具有良好的诊断价值，明显优于血清 GPC3 和 AFP检测对肝癌的诊断价值。2．GPC3 适配子对小肝癌和 AFP 阴性肝癌也有良好的诊断价值。3．适配子联合检测分析能进一步提高其对包括小肝癌和 AFP 阴性肝癌在 内的肝癌诊断价值。关键词：适配子；肝癌诊断；磷脂酰肌醇蛋白聚糖 3；荧光检测；联合分析ABSTRACTBackground and objective:AFP and medical imaging are currently two main methods for screening of primary hepatic cancer (PHC), and they are not ideal clinical practice. About 30%~40% of patients with PHC and most small PHC are AFP-negative, and it is also not easy for medical imaging to detect of small PHC. Some studies showed that GPC3 was specifically expressed in PHC tissue and could release into blood as a potential biomarker for the diagnosis of PHC. Serum GPC3 is generally assayed by immunological method, but it is difficult for clinical application due to the poor sensitivity of method. Aptamers, artificial nucleic acid ligands of biological molecules, are capable of binding to targets with high specificity andaffinity and therefore valuable in diagnostic application. In our previous work, weselected a group of aptamers against GPC3 by SELEX. In this study, we will evaluate their value in the diagnosis of PHC by a fluorescence-based method which we previously developed.Methods:Collection of serum specimen and clinical data: The leftover serum specimens were collected from the patients with PHC, liver cirrhosis (LC), chronic hepatitis and normal people for health checkup (normal control) hospitalized in the First Affiliated Hospital of Nanchang University from 2013 to 2014 and refrigerated