探讨血清异常凝血酶原(protein induced by vitamin K absence or antagonist-Ⅱ，PIVKA-Ⅱ)和甲胎蛋白(alpha fetoprotein，AFP)在原发性肝癌(primary hepatocellular carcinoma，PHC)中的诊断和疗效监测的临床应用。

收集2015年11月至2017年11月期间昆明市第三人民医院572例血清，采用全自动免疫分析仪和全自动免疫分析仪分别检测血清标本PIVKA-Ⅱ和AFP水平，分析两者单独及联合检测诊断PHC的受试者工作曲线下面积(ROC-AUC)、敏感度和特异性，比较PHC患者治疗前后血清水平的变化。

PHC患者血清PIVKA-Ⅱ和AFP水平均明显高于肝硬化组、慢性乙型肝炎组、肝内胆管细胞癌组和健康对照组。PIVKA-Ⅱ诊断是PHC的敏感度87.28%，高于AFP诊断PHC的敏感度70.52%。PIVKA-Ⅱ和AFP联合检测诊断PHC的敏感度94.21%。采用PIVKA-Ⅱ和AFP联合诊断方案，可提高诊断PHC的敏感性和特异性。PHC患者接受治疗后，PIVKA-Ⅱ和AFP水平均显著降低，与治疗前比较差异具有统计学意义(P<0.05)。

血清PIVKA-Ⅱ和AFP对PHC的诊断和疗效监测均具有较高的临床应用价值，联合检测可进一步提高敏感度和特异性。

To explore the clinical application of protein induced by vitamin K absence or antagonist-II (PIVKA-II) and alpha fetoprotein (AFP) in the diagnosis and curative effect monitoring of primary hepatocellular carcinoma (PHC).

The serum levels of PIVKA-II and AFP in 572 patients from The Third People′s Hospital of Kunming from November 2015 to November 2017 were detected by automatic immunoanalyzer and automatic immunoanalyzer respectively. The area under the working curve (ROC-A) of the subjects diagnosed PHC by the two methods were analyzed separately and jointly. The sensitivity and specificity were also compared before and after treatment in patients with PHC.

The serum levels of PIVKA-II and AFP in PHC patients were significantly higher than those in liver cirrhosis group, chronic hepatitis B group, intrahepatic cholangiocarcinoma group and healthy controls. The sensitivity of PIVKA-II in the diagnosis of PHC was 87.28%, higher than that of AFP (70.52%). The sensitivity of both PIVKA-II and AFP in the diagnosis of PHC was 94.21%. Combination of PIVKA-II and AFP can improve the sensitivity and specificity of PHC diagnosis. After treatment, PIVKA-II and AFP levels in patients with PHC were significantly lower than those before treatment (P<0.05).

Serum PIVKA-II and AFP have high clinical value in the diagnosis and curative effect monitoring of PHC. Combined detection of these two markers can further improve the sensitivity and specificity.