超声造影肝脏影像报告和数据管理系统分类联合血清热休克蛋白90α、异常凝血酶原鉴别肝细胞癌和肝内胆管细胞癌  

Contrast-enhanced ultrasound liver imaging reporting and data system classification combined with serum heat shock protein 90α and protein induced by vitamin K absence or antagonist-Ⅱin differentiating hepatocellular carcinoma and intrahepatic cholangiocarcinoma

作　　者：李娟[1] 郑佳利[1] 路秋晨 熊敏[1] 匡铭[2] LI Juan;ZHENG Jiali;LU Qiuchen;XIONG Min;KUANG Ming(Ultrasound Medicine Department,Mianyang Central Hospital,Mianyang,Sichuan 621000,China;Hepatobiliary Surgery,Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]绵阳市中心医院超声医学科,四川绵阳621000 [2]绵阳市中心医院肝胆外科,四川绵阳621000

出　　处：《安徽医药》2023年第6期1126-1129,共4页Anhui Medical and Pharmaceutical Journal

基　　金：四川省卫生健康委员会科研课题(19PJ115);绵阳市卫生健康委员会医学科研课题(202112)。

摘　　要：目的 探讨血清热休克蛋白90α(HSP90α)、异常凝血酶原(PIVKA-Ⅱ)联合超声造影肝脏影像报告和数据管理系统(LIRADS)分类在肝细胞癌和肝内胆管细胞癌中的鉴别诊断价值。方法 选取绵阳市中心医院2020年5月至2021年11月确诊的35例肝内胆管细胞癌(ICC)病人为ICC组,另选取105例肝细胞癌病人为肝细胞癌组。采用全自动发光免疫分析仪检测血清PIVKA-Ⅱ水平,采用ELISA法检测血清HSP90α水平,对所有病人进行超声造影检查,根据LI-RADS分类系统收集各超声特征;受试者操作特征(ROC)曲线分析超声造影LI-RADS-M(简称LR-M)类特征(动脉期环状高增强、门脉早期消退、显著消退)、血清HSP90α、PIVKA-Ⅱ及三者联合诊断ICC的价值。结果 与肝细胞癌组[(8.89±1.63)μg/L,(526.18±83.75)mAU/mL,16.19%,10.48%,15.24%,6.67%,48.57%,21.90%]相比,ICC组血清HSP90α(12.15±2.56)μg/L、PIVKA-Ⅱ(679.42±95.74)mAU/mL水平及胆管扩张(60.00%)、肿瘤边界模糊(60.00%)、形态不规则(62.86%)、动脉期环状高增强(51.43%)、门脉早期消退(94.29%)、显著消退(65.71%)比例显著较高(P<0.05)。超声造影LR-M类特征、血清HSP90α、PIVKA-Ⅱ及三者联合诊断ICC的曲线下面积(AUC)及其95%CI分别为0.80(0.72,0.88)、0.78(0.71,0.90)、0.78(0.68,0.87)、0.90(0.82,0.98),其中联合诊断效能最佳。结论超声造影LR-M类特征和血清HSP90α、PIVKA-Ⅱ联合后对ICC有较高的诊断性能,可有效鉴别诊断肝细胞癌和ICC。Objective To investigate the differential diagnostic value of serum heat shock protein 90α(HSP90α)and protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ)combined with contrast-enhanced ultrasound liver imaging reporting and data system(LI-RADS)classification in hepatocellular carcinoma and intrahepatic cholangiocarcinoma.Methods Thirty-five patients with intrahepatic cholangiocarcinoma(ICC)diagnosed in Mianyang Central Hospital from May 2020 to November 2021 were collected as the ICC group,and another 105 patients with hepatocellular carcinoma were collected as the hepatocellular carcinoma group.The serum PIVKA-Ⅱlevel was measured by automatic luminescence immunoassay,and the serum HSP90αlevel was measured by ELISA,contrast-enhanced ultrasound was performed on all patients,and the ultrasound characteristics were collected according to the LI-RADS classification system;receiver operating characteristic(ROC)curve was performed to analyze the value of CEUS LI-RADS-M(abbreviated as LRM)features(circular hyperenhancement in arterial phase,early regression of portal vein,significant regression),serum HSP90α,PIVKA-Ⅱ,and their combination in the diagnosis of ICC.Results Compared with the hepatocellular carcinoma group[(8.89±1.63)μg/L,(526.18±83.75)mAU/mL,16.19%,10.48%,15.24%,6.67%,48.57%,21.90%],the serum HSP90α(12.15±2.56)μg/L,PIVKA-Ⅱ(679.42±95.74)mAU/mL,bile duct dilatation(60.00%),blurred tumor boundary(60.00%),irregular shape(62.86%),annular hyperenhancement in the arterial phase(51.43%),early regression of the portal vein(94.29%),and significant regression ratio(65.71%)were significantly higher in the ICC group(P<0.05).The areas under the curve(AUC)and its 95%CI of CEUS LR-M features,serum HSP90α,PIVKA-Ⅱand their combination in the diagnosis of ICC were 0.80(0.72,0.88),0.78(0.71,0.90),0.78(0.68,0.87),0.90(0.82,0.98),respectively,among which the combined diagnostic efficiency was the best.Conclusion CEUS LR-M features combined with serum HSP90αand PIVKA-Ⅱhas high diagnostic perfor

关 键 词：超声检查 胆管 肝内 癌 肝细胞 血管造影术 超声造影 肝脏影像报告和数据管理系统 热休克蛋白90Α 异常凝血酶原 肝内胆管细胞癌 诊断 

分 类 号：R735.7[医药卫生—肿瘤]