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Journal of the Korean Academy of Family Medicine 1999;20(10):1209-1215.
Published online October 1, 1999.
A study on the validity of serum a alpha-fetoprotein for the screening of hepatocelluar carcinoma among Korean adults.
Jong Deuk Jun, Sun Woo Song, Yong Sik Kim
Department of Family Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Korea.
원발성 간암에 대한 선별검사로서 알파태아단백 ( a FP ) 검사의 타당성
김영식, 선우성, 전종득
Abstract
Background
: Serum alpha-fetoprotein(aFP) is a useful diagnostic test on hepatocellular carcinoma(HCC) However, it is still questionable appropriate screening test or not

Methods : A total of 24,050 patients who visited the General Health Screening Center of Asan Medical Center from June, 1993 to June, 1994, were reviewed by chart and telephone survey. Among them 70 cases where serum aFP were elevated > 20ng/ml and 16 cases where HCC was suspected by abdominal ultrasonogram were selected and investigated for the existence of HCC. Four groups were divided into HBsAg(+), Anti-HCV(+), increased AST/ALT(abnormal LFT) and normal group. Each group was evaluated for sensitivity, specificity, positive, predictive value and negative predictive value of serum aFP for HCC.

Results : The prevalence of elevated aFP was 0.29%(70/24,050). There was a statistically significant difference between sexes. And the total number of HCC as 10 cases (42/100,000). With aging, the prevalence of HCC was increased. The prevalence rate pf elevated serum aFP and HCC had significant difference in anti-HCV(+), HBsAg(+) and abnormal LFT group compared to normal group(sGOT < 40U/1, HBsAg(-) and Anti-HCV(-)) (P<0.01).
In our study, sensitivity and positive predictive value of serum aFP for HCC were 100% and 14% in anti-HCV(+) group, 83.3% and 8.6% in abnormal LFT group, 80% in HBsAg(+) group, and 0% in normal group, respectively.

Conclusion : Serum aFP as a screening test for HCC in asymptomatic healthy people does not seem to be not valid. But it seems to be appropriate when it is applied for cases of abnormal LFT(sGOT >40U/1 or sGPT > 40U/1), HBsAg(+) and Anti-HCV(+) people.
초록
연구배경 : 종합건강진단에서 간암에 대한 선별검사로서 흔히 이용되고 있는 혈성 알파태아단백(alpha-fetoprotein) 검사의 타당도를 평가하여 그 적용의 효율성을 알아보고자 한다.

방법 : 1993년 6월 1일부터 1994년 6월 30일까지 서울중앙병원 건강증진 센터에 내원한 총 24,050명을 대상으로 알파태아단백(aFP), 복부초음파, 간기능검사, HBsAg, anti-HCV 검사 결과를 조사하였다. 혈청 aFP 검사치가 증가(>20ng/ml) 되었던 70명과 초음파검사에서 간암이 의심되었던 16명의 의무기록 검색과 면접조사를 통해 간암여부를 확인하였다.
HBsAg 양성자, Anti-HCV 양성자, 간기능 이상자 (AST>40u/l or ALT>40u/l) 및 정상군으로 나누어 혈청 알파태아단백(aFP)의 간암선별에 대한 각각의 민감도, 특이도, 양성예측도와 음성예측도를 비교하였다.

결과 : 24,05명 중 혈청 알파태아단백(aFP)이 증가한 사람은 70명(0.29%)이었고, 남자에서 비정상 알파태아단백(aFP) 유병률이 0.37%로 여자의 0.17% 보다 유의하게 높았다. (P<0.05) 전체 대상자 중 간암환자는 10명(남자 : 8명, 여자 :2명)으로 유병률은 10만병당 42명으로 나타났다. 알파태아단백(aFP) 검사의 원발성 간암 선별검사에 대한 민감도와 양성예측도는 각각 Anti-HCV 양성자 군에서 100%와 14.0%로 가장 높게 나타났고, 간기능 이상자 군에서 83.3%와 8.6%, HBsAg 양성자 군에서 80%, 8.0%, 정상군에서는 두가지 모두 0%로 나타났다.

결론 : 간질환이 없는 무증상 건강인을 대상으로 간암의 선별검사를 위한 혈청 알파태아단백(aFP)검사는 타당성이 없어 보이며, 간기능 이상자, HBsAg 양성자, Anti-HCV 양성자 중에서 40세 이상인자를 대상으로 시행하는 것이 보다 효과적인 것으로 추정된다.
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