超声造影评估肝硬化小肝癌的价值及其与血清AFP-L3、GPC3、GP73水平的关系  

The significance of contrast-enhanced ultrasound in assessing hepatocellular carcinoma in cirrhotic patients and its association with serum levels of AFP-L3,GPC3 and GP73

作　　者：刘翠翠 贺薏 邱婧琦 梁爽 王倩 张志博 LIU Cui-cui;HE Yi;QIU Jing-qi;LIANG Shuang;WANG Qian;ZHANG Zhi-bo(Department of Ultrasound,Dongfang Hospital Qinhuangdao Hospital,Beijing University of Traditional Chinese Medicine(Qinhuangdao Traditional Chinese Medicine Hospital),Hebei 066000,China)

机构地区：[1]北京中医药大学东方医院秦皇岛医院(秦皇岛市中医医院超声科),河北066000

出　　处：《肝脏》2024年第9期1056-1059,1073,共5页Chinese Hepatology

基　　金：河北省自然科学基金资助项目(H2021206140)。

摘　　要：目的分析超声造影在评估肝硬化伴小肝癌中的应用价值,及其与血清AFP-L3、GPC3、GP73水平之间的相关性。方法选取2020年1月至2023年1月秦皇岛市中医医院接收的肝硬化患者124例,其中小肝癌患者为观察组(n=71),良性病变患者为对照组(n=53)。对两组患者进行超声造影检测,对比分析其动脉期、门静脉期和延迟期的增强特征,以及超声造影的各项指标:达峰时间(TTP)、峰值强度(PI)、增强时间(ET)、增强斜率(ES)和微血管密度(MVD),并检测甲胎蛋白异质体-L3(AFP-L3)、磷脂酰肌醇蛋白聚糖-3(GPC3)、高尔基体糖蛋白-73(GP73)等癌症相关标志物。Pearson相关分析超声造影参数与肿瘤标志物之间的相关性,ROC曲线下面积(AUC)评估超声造影的诊断效能。结果观察组患者动脉门高增强例数、PI、ES、MVD、AFP-L3、GPC3、GP73水平分别为65例、(28.93±2.14)dB、(2.42±0.48)、(52.35±4.12)条、(1409.57±15.02)ng/L、(751.48±62.68)pg/mL、(120.43±12.53)ng/mL,均高于对照组的17例、(22.10±1.67)dB、(0.86±0.21)、(31.84±2.47)条、(1213.35±13.74)ng/L、(583.84±49.11)pg/mL、(106.59±10.71)ng/mL,差异均有统计学意义(P<0.05)。观察组TTP和ET分别为(26.12±2.01)s、(19.07±1.73)s,对照组分别为(35.23±2.78)s、(23.64±2.04)s,差异均有统计学意义(P<0.05)。相关性分析表明肿瘤生物标志物的水平与PI、ES和MVD显示出正相关性,与TTP、ET呈负相关(P<0.05)。TTP、PI、ET、ES和联合检测评估肝硬化小肝癌的AUC分别为0.857、0.872、0.887、0.855、0.943。结论超声造影参数与肝硬化伴小肝癌患者的肿瘤标志物水平有显著相关性,且具有较高的诊断价值,值得临床推广。Objective To evaluate the efficacy of Contrast-Enhanced Ultrasound(CEUS)in assessing hepatocellular carcinoma(HCC)in cirrhotic patients and its association with serum levels of Alpha-fetoprotein-L3(AFP-L3),Glypican-3(GPC3),and Golgi Protein-73(GP73).Methods A total of 124 patients with cirrhosis treated between January 2020 and January 2023 were selected as study subjects.Within them,seventy one patients with small HCC were set as the observation group,and 53 patients with benign lesions were designated as the control group.All patients underwent CEUS to compare the arterial phase,portal phase,and delayed phase enhancement,as well as CEUS parameters(TTP,PI,ET,ES),and MicroVascular Density(MVD).Tumor markers including AFP-L3,GPC3,and GP73 were also measured.Pearson correlation analysis was used to investigate the relationship between CEUS parameters and tumor markers,and the diagnostic efficiency of CEUS was analyzed using ROC curve method.Results The number of cases with arterial portal enhancement,PI,ES,MVD,and levels of AFP-L3,GPC3,GP73 in the observation group were 65 cases,(28.93±2.14)dB,(2.42±0.48),(52.35±4.12)strips,(1409.57±15.02)ng/L,(751.48±62.68)pg/mL,(120.43±12.53)ng/mL,respectively,all higher than those in the control group[17 cases,(22.10±1.67)dB,(0.86±0.21),(31.84±2.47)strips,(1213.35±13.74)ng/L,(583.84±49.11)pg/mL,(106.59±10.71)ng/mL],with P<0.05.The TTP and ET in the observation group were(26.12±2.01)s and(19.07±1.73)s,and in the control group were(35.23±2.78)s and(23.64±2.04)s,respectively,with the observation group being lower than those of the control group,P<0.05.Correlation analysis showed that the levels of tumor biomarkers were positively correlated with PI,ES,and MVD,and negatively correlated with TTP and ET(P<0.05).The area under the ROC curve reached 0.972.Conclusion There is a significant correlation between CEUS parameters and serum levels of tumor markers in cirrhotic patients with HCC.CEUS has a high diagnostic value which is worthy of clinical promotion.

关 键 词：超声造影 肝硬化伴小肝癌 血清指标 Pearson分析 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]