三期增强CT扫描联合血清AFP和VEGF水平诊断肝细胞癌患者临床研究*

doi:10.3969/j.issn.1672-5069.2024.02.023

摘要/Abstract

摘要： 目的探讨多层螺旋CT(MSCT)三期增强扫描联合血清甲胎蛋白(AFP)和血管内皮生长因子(VEGF)水平对肝内占位性病变的诊断价值。方法 2021年1月～2022年12月我院诊治的肝内占位性病变患者82例, 均接受MSCT平扫和三期增强扫描检查, 采取细针穿刺活检或手术组织行常规病理学检查。采用免疫化学发光法检测血清AFP水平, 采用ELISA法检测血清VEGF水平。绘制受试者工作特征曲线(ROC)并计算曲线下面积(AUC)分析三期增强CT扫描联合血清AFP和VEGF水平诊断肝细胞癌(HCC)的效能。结果在本组82例肝占位患者中, 病理学检查诊断肝细胞癌(HCC)43例, 局灶性增生性结节(FPN)39例, MSCT扫描诊断原发性肝癌(PLC)36例, 诊断良性病灶46例;HCC病灶平扫及增强动脉期、门静脉期和延迟期CT值分别为(33.2±1.7)、(68.2±2.4)、(61.5±1.2)和(31.9±1.6), 均显著低于FPN病灶【分别为(40.1±2.5)、(92.5±3.1)、(76.8±2.6)和(63.2±3.7), P＜0.05】;HCC患者血清AFP和VEGF水平分别为(310.5±25.3)ng/mL和(97.6±62.1)ng/L, 均显著高于FPN患者【分别为(23.6±3.2)ng/mL和(65.4±19.8)ng/L, P＜0.05】;MSCT诊断恶性病变的灵敏度和特异度分别为81.4%和97.4%, 采用CT联合血清指标诊断可以将诊断的灵敏度和特异度都提高到97.4%。结论应用三期增强CT扫描扫描联合血清AFP和VEGF水平对判断肝内占位性病变的性质有帮助, 值得进一步研究。

关键词: 肝细胞癌, 肝内局灶性增生性结节, 多层螺旋CT, 甲胎蛋白, 诊断

Abstract: Objective The purpose of this study was to investigate the qualitative diagnosis by multi-slice spiral CT (MSCT) and serum alpha-fetoprotein (AFP) and vascular endothelial growth factor (VEGF) detection combination in patients with intrahepatic space-occupying lesions (SOL). Methods 82 patients with intrahepatic SOL were encountered in our hospital between January 2021 and December 2022, and all patients underwent MSCT plain and contrast-enhanced scans. Serum AFP level was detected by chemiluminescence, and serum VEGF level was detected by ELISA. The diagnostic performance was evaluated by the area under the receiver operating characteristic (AUROC) curves. Results Out of the 82 patients with intrahepatic SOL, the pathological examination showed hepatocellular carcinoma (HCC) in 43 cases, and focal proliferative nodules (FPN) in 39 cases, while the MSCT scan diagnosed primary liver cancer (PLC)in 36 cases and benign lesions in 46 cases; the CT value at plain, contrast-enhanced arterial, portal and delayed phases in HCC lesions were (33.2±1.7), (68.2±2.4), (61.5±1.2) and (31.9±1.6), all significantly lower than in FPN lesions; serum AFP and VEGF levels in patients with HCC were (310.5±25.3)ng/mL and (97.6±62.1)ng/L, both significantly higher than in patients with FPN; the sensitivity (Se) and specificity (Sp) by MSCT in determining malignant lesions were 81.4% and 97.4%, while they both increased to 97.4% when the CT scan was combined with these two serum parameters. Conclusion The combination of contrast-enhanced MSCT scan and serum AFP and VEGF detection could help determine the quality of intrahepatic SOL, which has a great implications in clinical practice.

Key words: Hepatoma, Focal proliferative nodules, Contrast-enhanced multi-slice spiral CT scan, Alpha-fetoprotein, Diagnosis

哈鹏, 苏晓晨, 付宾鹏. 三期增强CT扫描联合血清AFP和VEGF水平诊断肝细胞癌患者临床研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 251-254.

Ha Peng, Su Xiaochen, Fu Binpeng. Qualitative diagnosis by multi-slice spiral CT and serum AFP and VEGF detection combination in patients with intrahepatic space-occupying lesions[J]. Journal of Practical Hepatology, 2024, 27(2): 251-254.

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三期增强CT扫描联合血清AFP和VEGF水平诊断肝细胞癌患者临床研究^*

Qualitative diagnosis by multi-slice spiral CT and serum AFP and VEGF detection combination in patients with intrahepatic space-occupying lesions

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