CT检查指标联合血清甲胎蛋白水平诊断良恶性肝脏结节价值研究*

doi:10.3969/j.issn.1672-5069.2025.05.032

摘要/Abstract

摘要： 目的本研究旨在分析血清甲胎蛋白 (AFP)水平联合CT检测病灶指标诊断肝脏结节良恶性的价值。方法 2021年10月～2023年10月我院收治的肝脏结节患者124例,行常规CT扫描,选择病灶感兴趣区,计算平均通过时间(MTT)、表面通透性(PS)、血容量(BV)和血流量(BF),采用ELISA法检测血清AFP、癌胚抗原(CEA)、癌抗原199(CA-199)和恶性肿瘤特异性生长因子(TSGF)水平,以术后组织病理学检查明确诊断。采用多因素Logistic回归分析评估影响恶性肿瘤发生的因素,应用ROC曲线分析CT指标联合血清指标鉴别诊断肝脏良恶性的效能。结果在本组124例肝内结节患者中,病理学检查诊断肝脏良性结节83例(66.9%)和恶性肿瘤41例(33.1%);恶性病灶CT检测的PS、BV和BF分别为(10.4±3.2)mL/(min·100 g)、(4.0±1.6)mL/100 g和(26.5±5.6)mL/(min·100 g),均显著高于良性病灶【分别为(6.2±1.5)mL/(min·100 g)、(1.9±0.5)mL/100 g和(17.9±3.5)mL/(min·100 g),P＜0.05】;恶性组血清AFP、CA-199和TSGF水平分别为(416.4±150.1)μg/L、(44.6±5.9)U/L和(78.3±8.3)U/mL,显著高于良性组【分别为(11.8±2.3)μg/L、(36.2±4.5)U/L和(59.7±6.2)U/mL,P＜0.05】; 多因素Logistic分析显示,CT检测的PS、BV和BF及血清AFP水平是影响恶性病灶的重要因素(P＜0.05);ROC曲线分析显示,CT检测的病灶指标联合血清AFP水平判断肝脏恶性结节的AUC为0.967(95%CI:0.927,1.000),其诊断的敏感度为95.1%,特异度为95.1%。结论 CT检测病灶指标联合血清AFP水平判断肝脏结节良恶性效能较高,有很大的临床应用价值。

关键词: 肝恶性肿瘤, 肝脏局灶性增生性结节, 甲胎蛋白, 多层螺旋CT, 诊断

Abstract: Objective This study aimed to investigate diagnostic performance of serum alpha-fetoprotein (AFP) levels and multilayer spiral CT-detected parameters in evaluating qualities of liver nodules. Methods Clinical data of 124 patients with liver nodules were collected in our hospital between October 2021 and October 2023, and all underwent CT scan for determination of mean transit time (MTT),permeability surface area product (PS), blood volume (BV) and blood flow (BF) of regions of interest. Serum AFP, carcinoembryonic antigen (CEA),carbohydrate antigen 199 (CA-199) and tumor specific growth factor (TSGF) levels were assayed by ELISA. Multivariate Logistic regression analysis and area under receiver operating characteristic curve (AUC) were applied to assess diagnostic efficacy. Results Of 124 patients with intrahepatic nodules, histo-pathological examination found benign lesions in 83 cases (66.9%) and malignant lesions in 41 cases (33.1%);PS, BV and BF in malignant lesions were (10.4±3.2)mL/(min·100 g), (4.0±1.6)mL/100 g and (26.5±5.6)mL/(min·100 g), all much higher than [(6.2±1.5)mL/(min·100 g), (1.9±0.5)mL/100 g and (17.9±3.5)mL/(min·100 g), respectively, P＜0.05] in benign ones; serum AFP, CA-199 and TSGF levels were (416.4±150.1)μg/L,(44.6±5.9)U/L and (78.3±8.3)U/mL, all much higher than [(11.8±2.3)μg/L,(36.2±4.5) U/L and (59.7±6.2)U/mL, respectively, P＜0.05] in benign lesions; multivariate Logistic regression analysis showed that PS, BV and BF as well as serum AFP levels were independent risk factors for HCC existence (P＜0.05);ROC analysis demonstrated that the AUC was 0.967(95%CI:0.927-1.000), with sensitivity of 985.1% and specificity of 95.1%, when CT parameters and serum AFP level combination in judging the quality of intrahepatic nodules. Conclusion CT parameters in combination with serum AFP levels could help in the differential diagnosis of benign and malignant intrahepatic nodules,which could guide clinical management.

Key words: Hepatoma, Liver focal nodular lesions, Alpha-fetoprotein, Multilayer spiral CT scan, Diagnosis

叶琴, 叶莉, 骆馨, 单勤星, 沈亦亮. CT检查指标联合血清甲胎蛋白水平诊断良恶性肝脏结节价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 767-770.

Ye Qin, Ye Li, Luo Xin, et al. Serum alpha-fetoprotein levels and multilayer spiral CT parameters in assessing benign and malignant liver nodules[J]. Journal of Practical Hepatology, 2025, 28(5): 767-770.

参考文献

[1] Israël-Biet D, Bernardinello N, Pastré J,et al. High-risk sarcoidosis: a focus on pulmonary, cardiac, hepatic and renal advanced diseases, as well as on calcium metabolism abnormalities. J Diagnostics (Basel), 2024, 14(4):395.
[2] 刘柯兵,赵萍,杨义春,等.肝脏局灶性结节增生的超声造影诊断表现.中国临床医学影像杂志,2021,32(6):423-425.
[3] 崔新伍.中国学者参加欧洲超声联合会年会并参与制定世界超声联合会肝脏超声造影指南.中华超声影像学杂志,2019,28(7):594.
[4] Liu H, Yao X, Xu B,et al. Efficacy and safety analysis of multislice spiral CT-guided transthoracic lung biopsy in the diagnosis of pulmonary nodules of different sizes. J Comput Math Methods Med, 2022, 2022:8192832.
[5] Yang H, Lu L, Guo W,et al. A longitudinal study of AFP trajectories andclinical outcomes in intermediate-stage hepatocellular carcinoma after hepatectomy. J Hepatocell Carc, 2024, 11:219-228.
[6] 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版).中华消化外科杂志,2017,16(7):635-647.
[7] Kobayashi S. Hepatic pseudolesions caused by alterations in intrahepatic hemodynamics. World J Gastroenterol, 2021, 27(46):7894-7908.
[8] Jin Y, Xu A. Clinical value of serum AFP and PIVKA-II for diagnosis, treatment and prognosis of hepatocellular carcinoma. J Clin Lab Anal, 2024, 38(4):e25016.
[9] Schizas D, Mastoraki A, Routsi E,et al. Combined hepatocellular-cholangiocarcinoma: An update on epidemiology, classification, diagnosis and management. Hepatobiliary Pancreat Dis Int, 2020, 19(6):515-523.
[10] Yu C, Sun C. Diagnostic value of multislice spiral computedtomography combined with serum AFP, TSGF, and GP73 assay in the diagnosis of primary liver cancer. Evid Based Complement Alternat Med, 2022, 2022:6581127.
[11] Ferda J, Frölich M, Ferdová E,et al. Neovascularization, vascular mimicry and molecular exchange: the imaging of tumorous tissue aggressiveness based on tissue perfusion. Eur J Radiol, 2023, 163:110797.
[12] Katayama Y, Uchino J, Chihara Y,et al. Tumor neovascularization and developments in therapeutics. Cancers (Basel), 2019, 11(3):316.
[13] Senarathna J, Prasad A, Bhargava A,et al. HemoSYS: a toolkit for image-based systems biology of tumor hemodynamics. Sci Rep, 2020, 10(1):2372.
[14] Jia P, Liu R, Liu Y,et al. Comparison of the value of colorDoppler ultrasound and multislice spiral CT in the differential diagnosis of benign and malignant nodules in the liver. Contrast Media Mol Imaging, 2022, 2022:5251966.
[15] Gulati R, Hanlon MA, Lutz M,et al. Phosphorylation-mediated activation ofβ-catenin-TCF4-CEGRs/ALCDs pathway is an essential event in development of aggressive hepatoblastoma. Cancers (Basel), 2022, 14(24):6062.
[16] Wijngaarden JE, Jauw YWS, Zwezerijnen GJC,et al. Non-specific irreversible⁸⁹Zr-mAb uptake in tumours: evidence from biopsy-proven target-negative tumours using ⁸⁹Zr-immuno-PET J. EJNMMI Res, 2024, 14(1):18.
[17] Nair B, Kuriakose A, Baby B,et al. Tumor-specific growth factor (TSGF): a futuristic tumor biomarker in early diagnosis of cancer. Adv Pharm Bull, 2023, 13(3):483-488.
[18] Johnson AM, Dudek JM, Edwards DK,et al. Analytical validation of a novel multi-target blood-based test to detect hepatocellular carcinoma. Expert Rev Mol Diagn, 2021, 21(11):1245-1252.
[19] Eldosoky MA, Hammad R, Elmadbouly AA,et al. Diagnostic significance of hsa-miR-21-5p, hsa-miR-192-5p, hsa-miR-155-5p, hsa-miR-199a-5p Panel and ratios in hepatocellular carcinoma on top of liver cirrhosis in HCV-infected patients. Int J Mol Sci, 2023, 24(4):3157.
[20] Kong Y, Jing Y, Sun H,et al. The diagnostic value of contrast-enhanced ultrasound and enhanced CT combined with tumor markers AFP and CA199 in liver cancer. J Healthc Eng, 2022, 2022:5074571.

CT检查指标联合血清甲胎蛋白水平诊断良恶性肝脏结节价值研究^*

Serum alpha-fetoprotein levels and multilayer spiral CT parameters in assessing benign and malignant liver nodules

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	中华医学会肝病学分会重型肝病与人工肝学组, 中华医学会肝病学分会终末期肝病营养与再生学组. 慢加急性肝衰竭诊治指南(2025 年版)[J]. 实用肝脏病杂志, 2025, 28(5): 641-647.
[2]	汤洁, 姜正伟, 周冰清, 蒋蓓莉, 张睿. 超声剪切波弹性成像检查联合APRI和FIB-4诊断血清HBeAg阳性慢性乙型肝炎患者肝纤维化程度价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 663-666.
[3]	王凌云, 梅英, 陈梦雪, 程洪锋, 应修泉, 余萍萍. 定量CT诊断体检人群非酒精性脂肪性肝病效能研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 687-690.
[4]	程中华, 唐楠, 谷硕, 李晨露. 非酒精性脂肪性肝病患者血清miR-122、miR-140-5p和miR-34a水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2025, 28(5): 695-698.
[5]	葛天明, 吴启源, 于小伟, 李冠武. 磁共振成像质子密度脂肪分数评估非酒精性脂肪性肝病患者肝脏脂肪变性临床价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 703-706.
[6]	汪闯, 周林, 高焕焕, 陈敬锋, 王彬阶. 脾切除术后乙型肝炎肝硬化患者血栓弹力图参数和凝血功能指标预测门静脉血栓形成的价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 739-742.
[7]	李嘉亮, 段艳, 申健, 王煜. 多普勒组织成像联合超声心动图检查诊断乙型肝炎肝硬化并发肝硬化性心肌病价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 743-746.
[8]	李新, 梅文娟, 张昊月. CEUS与增强CT/MRI LI-RADS分类诊断小肝细胞癌应用研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 755-758.
[9]	刘静芳, 张苏波, 丁军明, 杨卫健. 定量动态增强MRI诊断肝脏局灶性病变价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 776-779.
[10]	倪沈珏, 王鹏飞, 黄燕华, 曹利华. 非酒精性脂肪性肝病患者血清Maresin-1、网膜蛋白-1和微小RNA-125b水平变化及其与病情严重程度的关系研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 533-536.
[11]	韩煜东, 张杰, 章文瑾, 何年安. 超声来源的脂肪分数诊断代谢相关脂肪性肝病应用研究[J]. 实用肝脏病杂志, 2025, 28(4): 553-556.
[12]	高晓婷, 高鑫, 刘艳莉, 康旺旺, 王海婷. 常规超声与超声造影评估肝硬化门静脉高压症患者TIPS术后支架功能价值分析^*[J]. 实用肝脏病杂志, 2025, 28(4): 589-592.
[13]	李慧慧, 姚晓松, 肖征, 陈念. 肝细胞癌与肝内胆管癌超声表现和超声造影增强特点分析^*[J]. 实用肝脏病杂志, 2025, 28(4): 597-600.
[14]	张聪, 张涛, 张骞. 超声造影诊断肝血管瘤及其预判肝动脉栓塞治疗的效果研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 601-604.
[15]	穆蕤, 李英, 刘萌雪, 杨卫健. 不典型肝脏局灶性结节性增生MRI征象表现研究^*[J]. 实用肝脏病杂志, 2025, 28(4): 605-608.