超声造影检查在甲胎蛋白阴性和阳性肝细胞癌诊断中的应用

摘要/Abstract

摘要： 目的回顾甲胎蛋白(AFP)阴性和阳性肝细胞癌(HCC)患者临床资料,旨在分析超声造影检查在HCC患者鉴别诊断中的应用价值。方法 2017年1月至2019年12月HCC患者90例(男62例、女28例),年龄(53.1±7.9)岁。计量资料以±s表示,t检验比较;计数资料以%表示,卡方检验比较。结果患者中AFP≥20 μg/L 56例,74个病灶,为AFP阳性组;AFP<20 μg/L 34例,38个病灶,为AFP阴性组。AFP阴性组[24(70.6%)]患者HBV例数显著低于AFP阳性组[51(91.1%),P<0.05];AFP阴性组患者病灶单发、多发例数为29(85.3%)、5(14.7%),AFP阳性组患者病灶单发、多发例数为37(66.1%)、19(33.9%),两者具有统计学差异(P<0.05);AFP阴性组[(2.9±1.4)cm]患者病灶直径显著小于AFP阳性组[(3.8±2.5)cm,P<0.05]。AFP阴性组、阳性组患者动脉期低回声、等回声及高回声病灶个数比较无明显差异(P>0.05)。AFP阴性组患者门脉期病灶低回声、等回声及高回声个数为9(23.7%)、25(65.8%)及4(10.5%),AFP阳性组患者门脉期病灶低回声、等回声及高回声个数为44(59.5%)、30(40.5%)及0(0),两者具有统计学差异(P<0.05)。AFP阴性组患者延迟期病灶低回声、等回声及高回声个数为22(57.9%)、16(42.1%)及0(0),AFP阳性组患者延迟期病灶低回声、等回声及高回声个数为58(78.4%)、16(21.6%)及0(0),两者不具有统计学差异(P<0.05)。AFP阴性组[(29.0±4.1)s]患者达峰时间显著长于AFP阳性组[(23.7±3.6)s,P<0.05];AFP阴性组[(98.7±6.7)s]患者流出时间也显著长于AFP阳性组[(90.4±7.1)s,P<0.05];AFP阴性组(2 158.4±210.6)患者曲线下面积显著小于AFP阳性组[(2 480.2±215.6),P<0.05];而两组患者到达时间无明显异常(P>0.05)。结论在超声造影成像中AFP阴性和阳性HCC患者均表现为快进快退,其中AFP阳性患者快进快出更为明显,超声造影检查有助于区分AFP阴性、阳性HCC。

关键词: 原发性肝细胞癌, 超声造影, 甲胎蛋白

Abstract: Objective To analyze the value of contrast-enhanced ultrasonography in the differential diagnosis of alpha-fetoprotein (AFP) negative and positive hepatocellular carcinoma (HCC) patients.Methods Between January 2017 and December 2019,there were 90 HCC patients (62 males and 28 females) enrolled,with an average age of (53.1±7.9) years.Measurement data (±s) were analyzed by t-test.Count data (%) were analyzed by chi-square test.Results There were 56 patients in AFP-positive (AFP ≥ 20 g/L) group with a total of 74 lesions,34 patients in AFP-negative (AFP <20 g/L) group with a total of 38 lesions.The incidence of hepatitis B virus infection in AFP-negative group (24/34,70.6%) was significantly lower than that in AFP-positive group (51/56,91.1%,P<0.05).There were 29 (85.3%) cases with single focus,5 (14.7%) cases with multiple foci in AFP-negative group,and 37 (66.1%) cases with single focus,19 (33.9%) cases with multiple foci in AFP-positive group.Difference was statistical between the 2 groups (P<0.05).The diameter of lesions in AFP-negative group [(2.9±1.4) cm] was significantly shorter than that in AFP-positive group [(3.8±2.5) cm,P<0.05].In arterial phase,there was no significant difference in the incidences of hypoechoic,isoechoic or hyperechoic lesions between AFP negative and positive groups.In portal phase,there were 9 (23.7%) cases of hypoechoic lesions,25 (65.8%) cases of isoechoic lesions,4 (10.5%) cases of hyperechoic lesions in AFP-negative group,and 44 (59.5%) cases of hypoechoic lesions,30 (40.5%) cases of isoechoic lesions,no cases of hyperechoic lesions in AFP-positive group.Differences were statistically significant (P<0.05).In delayed phase,there were 22 (57.9%) cases of hypoechoic lesions,16 (42.1%) cases of isoechoic lesions,no cases of hyperechoic lesions in AFP-negative group,and 58 (78.4%) cases of hypoechoic lesions,16 (21.6%) cases of isoechoic lesions,no cases of hyperechoic lesions in AFP-positive group.Differences were statistically significant (P<0.05).The peak time in AFP-negative group [(29.0±4.1) s] was significantly longer than that in AFP-positive group [(23.7±3.6) s,P<0.05].The retention time in AFP-negative group [(90.4±7.1) s] was significantly shorter than that in AFP-positive group [(98.7±6.7) s,P<0.05].The area under the receiver operating characteristic curve in AFP-negative group (2158.4±210.6) was significantly less than that in AFP-positive group [(2480.2±215.6),P<0.05].However,the arrival time has no significant difference between the 2 groups (P>0.05).Conclusion In contrast-enhanced ultrasound imaging,both AFP negative and positive HCC patients show fast-in and fast-out enhancement,especially in AFP-positive patients.Contrast-enhanced ultrasound is helpful in distinguishing AFP-negative and AFP-positive HCC.

Key words: Primary hepatocellular carcinoma, Contrast-enhanced ultrasonography, Alpha-fetoprotein

胡健, 刘明春, 王瑜, 怀玉水. 超声造影检查在甲胎蛋白阴性和阳性肝细胞癌诊断中的应用[J]. 肝脏, 2020, 25(11): 1178-1180.

HU Jian, LIU Ming-chun, WANG Yu, HUAI Yu-shui. Application of contrast-enhanced ultrasonography in the diagnosis of alpha-fetoprotein negative and positive hepatocellular carcinoma[J]. Chinese Hepatolgy, 2020, 25(11): 1178-1180.

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