Sonazoid超声造影联合血清甲胎蛋白和PIVKA-Ⅱ水平诊断肝脏局灶性病变价值研究*

doi:10.3969/j.issn.1672-5069.2025.06.028

摘要/Abstract

摘要： 目的探讨示卓安超声造影(sonazoid CEUS)联合血清甲胎蛋白(AFP)和异常凝血酶原(PIVKA-Ⅱ)水平诊断肝脏局灶性病变(FLL)的临床应用价值。方法 2019年5月～2024年7月我院收治的80例FLL患者,均接受Sonazoid CEUS检查和肝活检,使用全自动免疫发光分析仪检测血清AFP和PIVKA-Ⅱ水平,绘制受试者工作特征(ROC)曲线评估CEUS联合血清AFP和PIVKA-Ⅱ诊断FLL的效能。结果在本组80例FLL患者中,组织病理学检查诊断肝细胞癌(HCC)43例,肝脏局灶性结节性增生13例,肝硬化增生结节19例和炎性假瘤5例;恶性组血清AFP和PIVKA-Ⅱ水平分别为(710.1±213.0)ng/ml和(56.0±18.0) mAU/ml,均显著高于良性组【分别为(8.4±1.5)ng/ml和(28.3±6.3)mAU/ml,P＜0.05】;CEUS检查诊断良性病变29例,恶性51例;超声诊断的51例恶性病变动脉期快进、门脉期快出和延长期完全廓清占比分别为86.3%、76.5%和88.2%,均显著高于良性病变的31.0%、0.0%和0.0%(P＜0.05);分别以血清AFP=400 ng/ml和PIVKA-Ⅱ=55 mAU/ml为截断点,联合CEUS诊断FLL的AUC=0.932(95%CI:0.853～0.976),其诊断的灵敏度为100.0%,特异度为86.5%,显著提高了诊断效能(P＜0.05)。结论采用Sonazoid CEUS联合血清AFP和PIVKA-Ⅱ水平判定FLL性质具有良好的诊断效能,临床应用价值高。

关键词: 肝脏局灶性病变, 示卓安超声造影, 甲胎蛋白, 异常凝血酶原, 诊断

Abstract: Objective The aim of this study was to investigate diagnostic performance of sonazoid contrast-enhanced ultrasound (CEUS) and serum alpha fetoprotein(AFP) and prothrombin induced by the absence of vitamin K or antagonist-II (PIVKA II) levels in determining quality of focal liver lesions (FLL). Methods 80 patients with FLL were admitted to our hospital between May 2019 andJuly 2024, and all of them underwent liver biopsies and sonazoid CEUS examination.Serum AFP and PIVKA-II levels were measured by chemiluminescence immunoassay. Receiver operating characteristic (ROC) curves wereplotted to explore the diagnostic efficacy of sonazoid CEUS and serum AFP and PIVKA-II level combination in judging the quality of FLL. Results Of the 80 patients with FLL, liver pathological examination proved hepatocellular carcinoma(HCC)in 43 cases, focal nodular hyperplasia (FNH) in 13 cases, cirrhotic nodule in 19 case and inflammtory pseudotumor in 5 cases; serum AFP and PIVKA-Ⅱ levels in malignant group were (710.1±213.0)ng/ml and (56.0±18.0) mAU/ml, both significantly higher than [(8.4±1.5)ng/ml and (28.3±6.3)mAU/ml, respectively,P＜0.05] in benign group; CEUS diagnosed benign lesions in 29 cases and malignant ones in 51 cases; of51 patients with malignant lesions diagnosed by CEUS, the percentages of fast-in at arterial phase, fast-out at portal phase and complete clearance at delayed phase in malignant group were86.3%, 76.5% and 88.2%, all much higher than 31.0%, 0.0% and 0.0%(P＜0.05) in benign group; the AUC was 0.932(95%CI:0.853-0.976), with sensitivity of 100.0% and specificity of 86.5%, when serum AFP=400 ng/ml and PIVKA-Ⅱ=55 mAU/ml were respectively set as the cut-off-value and combined with CEUS in determining the quality of FLL, much superior to any parameter did alone(P＜0.05). Conclusion Sonazoid CEUS and serum AFP and PIVKA-II level combination isgenerally accuracy in diagnosing quality of focal liver lesions, which might help clinicians make an appropriate intervention as early as possible.

Key words: Focal liver lesion, Sonazoid contrast-enhanced ultrasound, Alpha fetoprotein, Prothrombin induced by the absence of vitamin K or antagonist-II, Diagnosis

郭芳兰, 孙丽芳, 闫苗苗, 王芮花. Sonazoid超声造影联合血清甲胎蛋白和PIVKA-Ⅱ水平诊断肝脏局灶性病变价值研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 910-913.

Guo Fanglan, Sun Lifang, Yan Miaomiao, et al. Diagnostic performance of sonazoid contrast-enhanced ultrasound and serum alpha fetoprotein and PIVKA-II levels in determining quality of focal liver lesions[J]. Journal of Practical Hepatology, 2025, 28(6): 910-913.

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Sonazoid超声造影联合血清甲胎蛋白和PIVKA-Ⅱ水平诊断肝脏局灶性病变价值研究^*

Diagnostic performance of sonazoid contrast-enhanced ultrasound and serum alpha fetoprotein and PIVKA-II levels in determining quality of focal liver lesions

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