Role of des-gamma-carboxy prothrombin in assessment of liver function and prognosis of patients with liver cirrhosis / 中华消化杂志

Objective@#To investigate the role of des-gamma-carboxy prothrombin (DCP) in assessment of liver function and prognosis of patients with liver cirrhosis. @*Methods@#From January 2013 to August 2016, a total of 137 patients with liver cirrhosis in Shanghai Changzheng Hospital were enrolled. The serum DCP level was measured, the clinical data was collected and the complication and survival situation was followed up. The 137 patients were divided into DCP negative group (DCP≤40 mAU/mL, 118 cases) and DCP positive group (DCP>40 mAU/mL, 19 cases). Forty-five patients with compensated liver cirrhosis were divided into high-level DCP group (DCP>16.5 mAU/mL, 32 cases) and low-level DCP group (DCP≤16.5 mAU/mL, 13 cases). Chi square test was used to analyze the difference in the positive rate of DCP in patients with different Child-Pugh classification. Spearman correlation test was performed to analyze the correlation between DCP and model for end-stage liver disease (MELD) scores. Kaplan-Meier survival curve was used to analyze the correlation between DCP and liver disease related mortality. @*Results@#Compared to that of DCP negative group, albumin level of patients in DCP positive group decreased (35 g/L, 20 to 57 g/L vs. 29 g/L, 17 to 42 g/L), however, total bilirubin (TBil), prothrombin time (PT), and international normalized ratio all increased (12.9 mg/L, 1.80 to 83.0 mg/L vs.22.2 mg/L, 6.4 to 169.0 mg/L; 15.5 s, 11.7 to 35.7 s vs.17.5 s, 13.9 to 33.4 s; 1.24, 0.96 to 3.72 vs.1.44, 1.09 to 3.22), and the differences were statistically significant (Z=-2.785, -2.891, -2.945 and -2.879, all P<0.01). The DCP positive (DCP>40 mAU/mL) rates of Child-Pugh A, B and C patients were 1.8% (1/55), 21.2% (11/52) and 23.3% (7/30), respectively, and the difference was statistically significant (χ2=11.246, P=0.003). The DCP levels of patients with Child-Pugh class B and C cirrhosis were significantly correlated with MELD scores (r=0.259, P=0.021). There were 16 and three patients with ascites and spontaneous bacterial peritonitis (SBP) of DCP positive group, and the incidence was higher than that of DCP negative group (55.1%, 65/118 and 1.7%, 2/118), and the differences were statistically significant (χ2=5.744 and 97.636, both P<0.05). Patients in high-level DCP group had a higher proportion of clinical decompensation than low-level DCP group (53.1% (17/32) and two cases), the difference was statistically significant (χ2=5.397, P=0.024). The overall survival rate of DCP positive group (nine survival cases) were lower than that of DCP negative group (87.9%, 87/99), and the difference was statistically significant (χ2=5.442, P=0.020). @*Conclusions@#Serum DCP level is closely related to liver function, ascites and SBP in patients with liver cirrhosis. Furthermore, it is associated with occurrence of decompensation in compensated patients and liver-related mortality in patients with liver cirrhosis. DCP may be a useful serum marker for evaluation of disease severity and prognosis in patients with liver cirrhosis in clinical practice.

PIVKA-II as a Serological Marker of Hepatocellular Carcinoma / 대한간학회지

No abstract available.

Combination Assay of Serum PIVKA-II and Alpha-fetoprotein in Primary Hepatocellular Carcinoma / 대한임상병리학회지

BACKGROUND: The serum des-gamma-carboxy prothrombin (PIVKA-II) is a tumor marker complementary to alpha-fetoprotein (AFP) for diagnosing primary hepatocellular carcinoma (HCC). A combination assay of the tumor markers was found to be useful for early diagnosis of HCC. So we investigated the clinical relevance of the measurement of serum PIVKA-II and AFP levels in patients with HCC. METHODS: The serum PIVKA-II levels were measured in 64 cases of HCC, 16 cases of cirrhosis, 32 cases of chronic hepatitis, and 23 healthy controls with a revised PIVKA-II ELISA Kit (Eisai, Tokyo, Japan), with the simultaneous determination of the serum AFP value using the AFP immunoassay kit (Elecsys, Roche, Germany). RESULTS: The positive rates of PIVKA-II and the AFP value in HCC were 53.1% and 68.8%, respectively, and were significantly higher than 17.6% and 29.4% in liver cirrhosis, and 3.1% and 0% in chronic hepatitis. No signficant correlation between the two tumor markers was found. The correlation between PIVKA-II levels and the size of tumor in HCC was found. No relation of the clinical characteristics to positive rates of PIVKA-II and AFP was found. The sensitivity, specificity and accuracy of PIVKA-II were 53.1%, 94.4% and 73.8%, and those of AFP were 68.8%, 93.1% and 80.9%, respectively. The sensitivity and accuracy in the combination assay for detection of HCC were higher than those in each assay, especially in HCC with the diameter of the tumor mass at less than 3 cm. CONCLUSIONS: It was demonstrated that the combination assay of PIVKA-II and AFP could increase the diagnostic value for HCC and could be useful in early diagnosis of HCC.