增强灌注扫描参数联合血清HMGA2、PIVKA-Ⅱ对肝硬化结节与原发性小肝癌鉴别诊断

摘要/Abstract

摘要： 目的评估增强灌注扫描参数及血清高迁移率族蛋白A2(HMGA2)和异常凝血酶原(PIVKA-Ⅱ)在鉴别诊断肝硬化结节与原发性小肝癌(HCC)的应用价值。方法选取2021年3月至2024年3月周口市中心医院收治的103例肝硬化患者作为研究对象,根据组织病理学检查分为肝硬化结节组(n=75)和原发性小肝癌组(n=28)。采用增强灌注扫描评估所有患者肝部病灶的血流动力学特征,同时测定血清HMGA2和PIVKA-Ⅱ水平,并分析其相关性。通过ROC曲线评估HMGA2和PIVKA-Ⅱ在鉴别诊断肝硬化结节与原发性小肝癌中的效能。结果结节组患者的年龄低于肝癌组分别为(35.7±10.4)岁比(62.5±12.7)岁,差异具有统计学意义(P<0.05)。肝癌组患者的血清HMGA2和PIVKA-Ⅱ水平均高于结节组,分别为(57.53±11.50)mg/L比(37.74±8.24)mg/L,(86.03±21.82)mAU/mL比(25.27±10.64)mAU/mL,差异均具有统计学意义(P<0.05)。肝癌组血流量、肝动脉灌注量、肝动脉分数、血容量均低于结节组,分别为血流量(186.85±14.27)mL/min·100 g比(202.17±15.42)mL/min·100 g,肝动脉灌注量(37.92±4.87)mL/min·100 g比(52.58±5.61)mL/min·100 g,肝动脉分数(0.20±0.03)比(0.28±0.04),血容量(165.27±18.53)mL/100 g比(175.63±20.47)mL/100 g,差异均具有统计学意义(P<0.05)。Pearson相关性分析显示,HMGA2与血流量、肝动脉灌注量、肝动脉分数、血容量存在负相关(r=-0.439、-0.624、-0.532、-0.220;均P<0.05),PIVKA-Ⅱ与血流量、肝动脉灌注量、肝动脉分数、血容量存在负相关(r=-0.378、-0.704、-0.665、-0.307;均P<0.05)。ROC曲线分析表明,联合使用HMGA2和PIVKA-Ⅱ在鉴别诊断肝硬化结节与原发性小肝癌上具有较高的价值,AUC值为0.969,灵敏度为96.4%,特异度为96.0%。结论增强灌注扫描参数结合血清HMGA2、PIVKA-Ⅱ可有效区分肝硬化结节与HCC,为早期诊断和治疗选择提供重要信息。

关键词: 增强灌注扫描, HMGA2, PIVKA-Ⅱ, 肝硬化结节, 原发性小肝癌, 鉴别诊断

Abstract: Objective This study aimed to evaluate the application value of enhanced perfusion scanning parameters and serum levels of High Mobility Group A2 (HMGA2) and Protein Induced by Vitamin K Absence or Antagonist-Ⅱ (PIVKA-Ⅱ) in the differential diagnosis between cirrhotic nodules and primary small hepatocellular carcinoma (HCC). Methods A total of 103 patients with liver cirrhosis treated at Zhoukou Central Hospital from March 2021 to March 2024 were selected for this study. Based on histopathological examination, patients were divided into a cirrhotic nodule group (n=75) and a primary small HCC group (n=28). Enhanced perfusion scanning was used to assess the hemodynamic characteristics of hepatic lesions. Serum levels of HMGA2 and PIVKA-Ⅱ were measured, and their correlation was analyzed. The efficacy of HMGA2 and PIVKA-Ⅱ in differential diagnosis was assessed using receiver operating characteristic (ROC) curve analysis. Results The age of patients in the nodule group was significantly lower than that in the HCC group (35.7±10.4 years vs. 62.5±12.7 years; P<0.05). Serum levels of HMGA2 and PIVKA-Ⅱ were significantly higher in the HCC group than those in the nodules group (HMGA2: 57.53±11.50 mg/L vs. 37.74±8.24 mg/L; PIVKA-Ⅱ: 86.03±21.82 mAU/mL vs. 25.27±10.64 mAU/mL; P<0.05). Blood flow, hepatic arterial perfusion, hepatic arterial fraction, and blood volume were significantly lower in the HCC group compared to the nodule group (blood flow: 186.85±14.27 mL/min·100 g vs. 202.17±15.42 mL/min·100 g; hepatic arterial perfusion: 37.92±4.87 mL/min·100 g vs. 52.58±5.61 mL/min·100 g; hepatic arterial fraction: 0.20±0.03 vs. 0.28±0.04; blood volume: 165.27±18.53 mL/100 g vs. 175.63±20.47 mL/100 g; P<0.05). Pearson correlation analysis showed a negative correlation between HMGA2 and blood flow, hepatic arterial perfusion, hepatic arterial fraction, blood volume (r=-0.439, -0.624, -0.532, -0.220; P<0.05 respectively), and similar negative correlation was found for PIVKA-Ⅱ (r=-0.378, -0.704, -0.665, -0.307; P<0.05 respectively). ROC curve analysis indicated that the combined use of HMGA2 and PIVKA-Ⅱ had high diagnostic value, with an AUC of 0.969, sensitivity of 96.4%, and specificity of 96.0%. Conclusion Enhanced perfusion scanning parameters combined with serum HMGA2 and PIVKA-Ⅱ effectively differentiate between cirrhotic nodules and HCC, providing important information for early diagnosis and treatment selection.

Key words: Enhanced perfusion scanning, HMGA2, PIVKA-Ⅱ, Cirrhotic nodules, Primary small hepatocellular carcinoma, Differential diagnosis

李铮, 康鑫崴. 增强灌注扫描参数联合血清HMGA2、PIVKA-Ⅱ对肝硬化结节与原发性小肝癌鉴别诊断[J]. 肝脏, 2025, 30(10): 1365-1369.

LI Zheng, KANG Xin-wei. Enhanced perfusion scanning parameters combined with serum HMGA2 and PIVKA-Ⅱ for the differential diagnosis of cirrhotic nodules and primary small hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(10): 1365-1369.

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