超声造影联合甲胎蛋白测定对高危人群肝细胞癌的临床筛查价值  

Clinical screening value of contrast-enhanced ultrasound combined with alpha-fetoprotein determination for hepatocellular carcinoma in high risk population

作　　者：范智慧 吴侠 黄玮[1] 李晶晶 李晓庆[1] 陈丽[2] 谷鹏程 武晓鹏 FAN Zhi-hui;WU Xia;HUANG Wei;LI Jing-jing;LI Xiao-qing;CHEN Li;GU Peng-cheng;WU Xiao-peng(Ultrasound Medicine Department,Kailuan General Hospital,Tangshan 063000,China;Magnetic Resonance Department,Kailuan General Hospital,Tangshan 063000,China;General Surgery Department,Guantao County Hospital,Handan 057750,China)

机构地区：[1]河北省唐山市开滦总医院超声医学科,河北唐山063000 [2]河北省唐山市开滦总医院核磁室,河北唐山063000 [3]河北省邯郸市馆陶县医院普通外科,河北邯郸057750

出　　处：《实用医院临床杂志》2024年第2期126-130,共5页Practical Journal of Clinical Medicine

基　　金：河北省2021年度医学科学研究课题计划(编号:20210402)。

摘　　要：目的探讨超声造影(CEUS)联合甲胎蛋白(AFP)测定对高危人群肝细胞癌(HCC)的临床筛查价值。方法收集2018年6月至2020年2月在我院接受检查的HCC高危人群117例共138枚肝局灶性病灶的临床资料,以病理结果为金标准,将病灶分为HCC组、非HCC恶性组、良性组,比较三组血清AFP水平、常规超声特征,采用超声造影肝脏影像报告和数据系统(CEUS-LI-RADS)分类标准对病灶进行分类,分析AFP、常规超声、CEUS-LR 4、5类、CEUS-LR 5类对高危人群HCC的诊断价值。结果117例患者共138枚病灶,经病理证实为HCC有77例(87枚),非HCC恶性肿瘤有13例(16枚),良性结节有27例(35枚)。HCC组AFP水平高于非HCC恶性组和良性组,非HCC恶性组高于良性组(P<0.05)。HCC组、非HCC恶性组形态不规则、边界不清、低回声、病灶大小≥3 cm占比高于良性组,HCC组中心血流丰富占比低于非HCC恶性组和良性组(P<0.05)。应用CEUS-LI-RADS分类检出LR1类3枚(2.17%),LR2类9枚(6.52%),LR3类29枚(21.01%),LR 4类13枚(9.42%),LR5类68枚(49.28%),LR-M类16枚(11.59%),常规超声、CEUS-LR4、5类、CEUS-LR5类诊断高危人群HCC的AUC分别为0.747、0.870、0.823,采用CEUS-LR4、5类联合AFP诊断高危人群HCC的AUC为0.923,较单一诊断的敏感度、特异度、约登指数及AUC均明显提高。结论CEUS-LR4、5分类对高危人群HCC的筛查效果优于CEUS-LR5类,CEUSLR4、5类联合AFP检查对高危人群HCC的筛查价值更高。Objective To explore the value of contrast-enhanced ultrasound(CEUS)combined with alpha-fetoprotein(AFP)in screening hepatocellular carcinoma(HCC)in high risk population.Methods Clinical data of 138 focal hepatic lesions in 117 patients at high risk of HCC in our hospital from June 2018 to February 2020 were collected.Using pathological findings as the gold standard,the lesions were divided into a HCC group,a non-HCC malignant group and a benign group.Serum AFP levels and conventional ultrasound characteristics were compared among the three groups.The liver Imaging Reporting and Data System(CEUSLI-RADS)was used to classify the lesions.The diagnostic value of AFP,conventional ultrasound,CEUS-LR4,5,and CEUS-LR5 in high risk population for HCC was analyzed.Results There were a total of 138 lesions in the 117 patients.Pathological analysis confirmed that 77 patients(87 lesions)were diagnosed as HCC,13 patients(16 lesions)as non-HCC malignant tumors and 27 patients(35 lesions)as benign nodules.The AFP levels in the HCC group was higher than the non-HCC malignant group and the benign group,and the non-HCC malignant group was higher than the benign group(P<0.05).The proportion of irregular shape,unclear boundary,low echo and lesion size≥3 cm in the HCC group and the non-HCC malignant group were higher than those in the benign group,and the proportion of rich central blood flow in the HCC group was lower than that in the non-HCC malignant group and the benign group(P<0.05).There were 3 lesions with LR1(2.17%),9 with LR2(6.52%),29 with LR3(21.01%),13 with LR4(9.42%),68 with LR5(49.28%)and 16 with LR-M(11.59%)by using CEUS-LI-RADS classification.The AUC(95%CI)of ROC curve analysis for conventional ultrasound,CEUS-LR4,5 and CEUS-LR5 in the diagnosis of HCC in high-risk populations were 0.747,0.870 and 0.823,respectively.The AUC(95%CI)of CEUS-LR4 and 5 combined with AFP in the diagnosis of HCC in highrisk populations was 0.923,which was significantly higher than the sensitivity,specificity,Jorden index and AUC of single di

关 键 词：超声造影 甲胎蛋白 高危人群 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]