TACE治疗前NGAL联合微血流成像技术的多模态超声技术对原发性肝癌微血管侵犯的预测价值

肝脏 ›› 2025, Vol. 30 ›› Issue (10): 1330-1334.

TACE治疗前NGAL联合微血流成像技术的多模态超声技术对原发性肝癌微血管侵犯的预测价值

冯艳梅, 吴娟, 骆玉姣

710000 西安陕西省第二人民医院功能科彩超室(冯艳梅);710065 西安陕西省康复医院影像二科(吴娟);710032 西安空军军医大学第一附属医院超声科(骆玉姣)

收稿日期:2024-09-30 出版日期:2025-10-31 发布日期:2025-12-16
通讯作者: 吴娟,Email:119101962@qq.com
基金资助:
陕西省自然科学基础研究计划项目(2020JM-373)

The predictive value of microvascular invasion in primary liver cancer using neutrophil gelatinase associated lipocalin expression in combination with microflow imaging before TACE treatment

FENG Yan-mei¹, WU Juan², LUO Yu-jiao³

1. Color Ultrasound Room, the Second People's Hospital of Shaanxi Province, Xi′an 710000, China;
2. Department of Imaging 2, Shaanxi Rehabilitation Hospital, Xi′an 710065, China;
3. Department of Ultrasound, the First Affiliated Hospital of Air Force Medical University, Xi′an 710032, China

Received:2024-09-30 Online:2025-10-31 Published:2025-12-16
Contact: WU Juan,Email: 119101962@qq.com

摘要/Abstract

摘要： 目的分析肝动脉化疗栓塞术(TACE)治疗前中性粒细胞明胶酶相关载脂蛋白(NGAL)表达联合微血流成像技术(MFI)的多模态超声技术对原发性肝癌(PLC)微血管侵犯(MVI)的预测价值。方法纳入陕西省第二人民医院2019年10月至2023年8月收治的86例行TACE治疗PLC患者,于治疗前采取酶联免疫吸附法检测NGAL水平并进行MFI的多模态超声技术检查。根据患者是否发生MVI分为两组,分析NGAL联合MFI的多模态超声技术评估PLC患者发生MVI的影响因素及预测价值。结果 86例PLC患者中,22例发生MVI(设为发生组),占比25.58%。发生组肝功能Child-Pugh 分级为C级为54.55%、血流分级为Ⅲ级为50.00%、肿瘤边缘不光滑为59.09%、门静脉相高增强为72.73%、NGAL(129.63±15.62)kU/L,分别高于未发生组的21.88%、14.06%、29.69%、43.75%、(120.14±6.47)kU/L(均P<0.05)。经logistic回归分析,结果显示:NGAL水平[OR=1.108(95% CI:1.040~1.179)]、肝功能Child-Pugh分级为C级[OR=4.286(95% CI:1.534~11.973)]、血流分级为Ⅲ级[OR=6.111(95% CI:2.048~18.285)]、门静脉相高增强[OR=3.429(95% CI:1.187~9.899)]、肿瘤边缘不光滑[OR=3.421(95% CI:1.252~9.345)]是预测PLC患者发生MVI的影响因素(均P<0.05)。经ROC曲线分析,NGAL水平、血流分级为Ⅲ级、门静脉相高增强、肿瘤边缘不光滑、肝功能Child-Pugh分级为C级及联合预测PLC患者发生MVI的灵敏度分别为72.70%、50.00%、72.70%、59.10%、54.50%、90.90%,特异度分别为79.70%、85.90%、56.20%、70.30%、78.10%、89.10%。且五项联合预测PLC患者发生MVI具有较高的价值(AUC为0.911)。结论 TACE治疗前NGAL表达联合MFI的多模态超声技术对预测PLC患者发生MVI的价值较高。

关键词: 肝动脉化疗栓塞术, 中性粒细胞明胶酶相关载脂蛋白, 微血流成像技术, 原发性肝癌, 微血管侵犯

Abstract: Objective To evaluate the predictive value of neutrophil gelatinase associated lipocalin (NGAL) expression combined with multimodal ultrasound of microflow imaging (MFI) for microvascular invasion (MVI) in primary liver cancer (PLC)before hepatic arterial chemoembolization (TACE) therapy. Methods A total of 86 PLC patients treated with TACE from October 2019 to August 2023 werecollected from the Second People's Hospital of Shaanxi Province. NGAL levels were detected by enzyme-linked immunosorbent assay and MFI multimodal ultrasonographys were performed before treatment. Patients were divided into an occurrence group (n=22) and a non-occurrence group (n=64) according to whether they had MVI or not, and the influencing factors and predictive value of multi-modal ultrasound technique combined with NGAL and MFI for MVI in PLC patients were analyzed. Results 22 of the 86 PLC patients (25.58%) had MVI and grouped as the occurrence group. 54.55% of them was Child-Pugh grade C, 50.00% of them was blood flow grade Ⅲ, 59.09% had unsmooth tumor edge, 72.73% had portal phase hyper-enhancement, and their average NGAL level was (129.63±15.62) kU/L, which were higher than those of 21.88%, 14.06%, 29 69%, 43.75%, and (120.14±6.47) kU/L, respectively, in patients of the non-occurrence group (P<0.05). Logistic regression equation analysis showed that NGAL level [OR=1.108 (95%CI: 1.040~1.179)], Child-Pugh grade C [OR=4.286 (95%CI: 1.534~11.973)], blood flow grade Ⅲ [OR=6.111 (95% CI: 2.048~18.285)], highly enhanced portal phase [OR=3.429 (95% CI: 1.187~9.899)], unsmooth tumor margin [OR=3.421 (95% CI: 1.252~9.345)] were influencing factors for predicting MVI in PLC patients (all P<0.05). Through ROC curve analysis, the sensitivities of NGAL level, blood flow grade Ⅲ, highly enhanced portal phase, unsmooth tumor edge, Child-Pugh grade C and their combination for predicting MVI in PLC patients were 72.70%, 50.00%, 72.70%, 59.10%, 54.50%, and 90.90%, respectively. The specificities were 79.70%, 85.90%, 56.20%, 70.30%, 78.10% and 89.10%, respectively. In addition, the combination of the aboval five items to predict MVI in PLC patients had a higher value (AUC 0.911). Conclusion The expression level of NGAL in combination with multimodal ultrasound technique of MFI has a higher value in predicting MVI in PLC patients before TACE treatment.

Key words: Hepatic arterial chemoembolization, Neutrophil gelatinase-associated apolipoprotein, Microflow imaging, Primary liver cancer, Microvascular invasion

冯艳梅, 吴娟, 骆玉姣. TACE治疗前NGAL联合微血流成像技术的多模态超声技术对原发性肝癌微血管侵犯的预测价值[J]. 肝脏, 2025, 30(10): 1330-1334.

FENG Yan-mei, WU Juan, LUO Yu-jiao. The predictive value of microvascular invasion in primary liver cancer using neutrophil gelatinase associated lipocalin expression in combination with microflow imaging before TACE treatment[J]. Chinese Hepatolgy, 2025, 30(10): 1330-1334.

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