超声造影联合血清AFP、CA199、CA125诊断早期肝癌的价值观察

摘要/Abstract

摘要： 目的探讨早期肝细胞癌(HCC)患者的超声造影(CEUS)特征、血清甲胎蛋白(AFP)、糖类抗原199(CA199)、糖类抗原125(CA125)变化及其诊断学价值。方法以病理结果作为诊断金标准,选取南京市高淳人民医院2018年8月—2021年8月确诊的80例早期HCC患者作为HCC组、80例肝脏良性结节患者作为良性组,对两组患者的CEUS特征参数进行对比分析,检测HCC组和良性组患者的血清AFP、CA199、CA125水平并进行统计学假设检验分析,分别以金标准诊断结果绘制2×2四格表,计算各种方式单独及联合使用的情况下鉴别诊断肝脏良恶性肿瘤的价值。结果 HCC组患者的单个病灶数目占比87.50%、边界特征不清晰占比30.00%、病灶形态不规则占比26.25%、病灶血供丰富占比26.25%、CEUS门脉期呈等增强或低增强占比80.00%、CEUS延迟期呈等增强或低增强的患者占比86.25%显著的高于良性组患者,上述指各项参数在HCC组和良性组之间比较差异显著(P<0.05);经实验室检查分析,HCC组患者的血清AFP(25.91±8.44)μg/L、CA199(41.46±10.20)U/mL、CA125(39.20±11.32)U/mL显著的高于良性组患者患者的AFP(16.42±6.73)μg/L、CA199(28.74±8.62)U/mL、CA125(27.13±7.57)U/mL(P<0.05);CEUS+AFP+CA125+CA199诊断HCC与肝脏良性肿瘤的灵敏度为95.00%、特异度为82.50%、漏诊率为5.00%、误诊率为17.50%、阳性预测值为84.44%、阴性预测值为94.29%。结论 CEUS+AFP+CA125+CA199诊断早期HCC与肝脏良性肿瘤较各项指标单独应用时能显著提高诊断的灵敏度,同时保证较好的诊断特异度。

关键词: 超声造影, 甲胎蛋白, 糖类抗原199, 糖类抗原125, 诊断, 肝细胞癌

Abstract: Objective To investigate diagnostic value of contrast-enhanced ultrasound (CEUS) characteristics and changes in serum alpha-fetoprotein (AFP), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125) in patients with early primary liver cancer (HCC). Methods Using pathological results as the gold standard for diagnosis, 80 patients with early HCC diagnosed in Nanjing Gaochun People's Hospital from August 2018 to August 2021 were selected as the HCC group, while 80 patients with liver benign nodules were selected as the benign group. The characteristic parameters of CEUS in the two groups were compared and analyzed. Serum levels of AFP, CA199 and CA125 in the HCC and benign group were measured and analyzed by statistical hypothesis testing. 2×2 four-grid tables were conducted based on the gold standard diagnosis results to evaluate the accuracy of different diagnosic methods when use alone and in combination for distinguishing between benign and malignant liver tumors. Results In the HCC group, 87.50% of cases had single lesions, 30.00% had unclear boundary features, 26.25% had irregular lesions, and 26.25% had rich blood supply. Additionally, 80.00% exhibited equal or low enhancement in the CEUS portal phase, and 86.25% displayed equal or low enhancement in the CEUS delay phase, all of which were significantly higher than those in the benign group. These parameters demonstrated significant differences between the HCC group and the benign group (P<0.05). Furthermore, laboratory examination revealed significantly higher levels of AFP (25.91 ± 8.44) μg/L, CA199 (41.46 ± 10.20) U/mL, and CA125 (39.20 ± 11.32) U/mL in the HCC group compared to the benign group (P<0.05), where the levels of AFP, CA199, and CA125 were (16.42 ± 6.73) μg/L, (28.74±8.62) U/mL, and (27.13±7.57) U/mL, respectively. The combination of CEUS, AFP, CA125, and CA199 demonstrated a sensitivity of 95.00%, specificity of 82.50%, missed diagnosis rate of 5.00%, misdiagnosis rate of 17.50%, positive predictive value of 84.44% and negative predictive value of 94.29% in the diagnosis of HCC and benign liver tumors. Conclusion The combined use of CEUS, AFP, CA125, and CA199 in the diagnosis of early HCC and benign liver tumors has been shown to significantly enhance diagnostic sensitivity and ensure superior diagnostic specificity compared to the application of each index individually.

Key words: Contrast-enhanced ultrasound, Alpha-fetoprotein, Carbohydrate antigen 199, Carbohydrate antigen 125, Diagnosis, Hepatocellular carcinoma

诸玮, 努尔波勒, 丁晓军. 超声造影联合血清AFP、CA199、CA125诊断早期肝癌的价值观察[J]. 肝脏, 2024, 29(2): 197-201.

ZHU Wei, Nurpol, DING Xiao-jun. The value of CEUS combined with serum AFP, CA199 and CA125 in the diagnosis of early hepatocellular carcinoma[J]. Chinese Hepatolgy, 2024, 29(2): 197-201.

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