磁共振成像增强扫描联合血清甲胎蛋白水平对肝癌患者的诊断价值

摘要/Abstract

摘要： 目的探讨磁共振成像增强扫描联合血清甲胎蛋白(AFP)水平在肝癌诊断中的应用效果。方法纳入2020年10月至2023年10月江苏省海安市人民医院收治的82例肝癌患者(观察组)与80例良性肝病患者(对照组),两组患者均进行磁共振成像增强扫描,检测患者血清AFP、ApoB、GGT、TSGF、CA19-9、CEA水平,采用Pearson相关性分析评估磁共振成像增强扫描参数与血清AFP、ApoB、GGT、TSGF、CA19-9、CEA水平的关系,并通过受试者工作特征(ROC)曲线评估磁共振成像增强扫描参数联合血清AFP水平在肝癌诊断中的价值。结果在K^trans、K_ep、V_e值上,观察组较对照组高[(0.56±0.21)比(0.31±0.17)、(1.53±0.41)比(1.06±0.32)、(0.44±0.15)比(0.22±0.08)];观察组血清AFP、GGT、TSGF、CA19-9、CEA水平较对照组高[(351.24±82.67)比(88.79±11.37)、(51.19±6.21)比(29.64±3.42)、(80.33±9.76)比(19.54±2.86)、(56.97±6.58)比(23.85±3.04)、(18.23±2.62)比(0.89±0.24)],ApoB水平较对照组低[(0.87±0.26)比(1.14±0.30)]。相关性分析结果显示,肝癌患者K^trans、K_ep、V_e与血清AFP、GGT、TSGF、CA19-9、CEA水平存在正相关关系,与ApoB水平则表现出负相关;ROC曲线结果表明:磁共振成像增强扫描参数联合血清AFP水平对肝癌患者的诊断灵敏度为95.1%,特异度为95.0%,AUC为0.973,优于单项检测。结论磁共振成像增强扫描参数联合血清甲胎蛋白水平对肝癌患者的诊断具有高灵敏度和特异度,在诊断肝癌方面的效果优于单一检测手段,可有效提高肝癌的诊断准确率。

关键词: 磁共振成像增强扫描, 血清甲胎蛋白, 肝癌, 诊断价值, 相关性

Abstract: Objective To explore the effectiveness of enhanced magnetic resonance imaging (MRI) combined with serum alpha-fetoprotein (AFP) level in diagnosing hepatocellular carcinoma (HCC). Methods The study included 82 HCC patients (observation group) and 80 patients with benign liver diseases (control group) treated at the People's Hospital of Hai′an City in Jiangsu Province from October 2020 to October 2023. Both groups underwent enhanced MRI and had their serum levels of AFP, apolipoprotein B (ApoB), gamma-glutamyl transferase (GGT), tumor supplied group of factor (TSGF), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) measured. Pearson's analysis was used to evaluate the relationship between MRI parameters and serum markers, and the diagnostic value of combining MRI parameters with serum AFP level was assessed using receiver operating characteristic (ROC) curves. Results In the observation group, the values of K^trans, K_ep, and V_e were higher than those in the control group [(0.56±0.21) vs. (0.31±0.17), (1.53±0.41) vs. (1.06±0.32), (0.44±0.15) vs. (0.22±0.08)]; serum levels of AFP, GGT, TSGF, CA19-9, and CEA were also higher [(351.24±82.67) vs. (88.79±11.37), (51.19±6.21) vs. (29.64±3.42), (80.33±9.76) vs. (19.54±2.86), (56.97±6.58) vs. (23.85±3.04), (18.23±2.62) vs. (0.89±0.24)], while ApoB levels were lower [(0.87±0.26) vs. (1.14±0.30)]. Correlation analysis indicated the positive relationships between K^trans, K_ep, V_e and serum AFP, GGT, TSGF, CA19-9, CEA levels, and a negative correlation with ApoB levels. ROC analysis demonstrated that the sensitivity and specificity of the combined MRI parameters and serum AFP levels in diagnosing hepatocellular carcinoma were 95.1% and 95.0% respectively, with an AUC of 0.973, which was superior to individual testing. Conclusion The combination of enhanced MRI parameters and serum AFP levels exhibits high sensitivity and specificity in diagnosing HCC. This combination method is more effective than single testing method, which can significantly improve the diagnostic accuracy of HCC.

Key words: Enhanced magnetic resonance imaging, Serum alpha-fetoprotein, Hepatocellular carcinoma, Diagnostic value, Correlation

任杰, 薛颖, 周恒琛. 磁共振成像增强扫描联合血清甲胎蛋白水平对肝癌患者的诊断价值[J]. 肝脏, 2025, 30(10): 1375-1378.

REN Jie, XUE Ying, ZHOU Heng-chen. Analysis of the diagnostic value of enhanced MRI scanning combined with serum alpha-fetoprotein levels in patients with hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(10): 1375-1378.

/ 推荐

参考文献

[1] 陈钰,陈斌斌,赵静,等. MRI联合血清AFP-L3和VEGF水平预测TACE术治疗的原发性肝癌患者预后的价值[J]. 实用肝脏病杂志,2023,26(4):556-559.
[2] 姚升娟,曲静琦,曹宇,等. MRI联合血清miR-204水平对原发性肝癌经皮穿刺射频消融术后疗效及复发的预测价值[J]. 放射学实践,2022,37(1):62-67.
[3] 欧文,李成杰,任鸿萍,等. 原发性肝癌MRI检查图像特征分析及联合血清AFP、TK1、DKK1的诊断价值研究[J]. 现代生物医学进展,2021,21(9):1777-1780.
[4] 黄勤烽,黄少铃,王水良,等. 血清AFP、CEA和CA199联合检测在丙肝相关肝硬化和肝癌鉴别诊断中的临床价值[J]. 西部医学,2023,35(7):1011-1014.
[5] 张化冰,齐杰,高战强,等. 磁共振扩散加权成像联合血清AFP对小肝癌临床诊断及疗效评估的价值[J]. 影像科学与光化学,2021,39(1):75-80.
[6] 张业繁,蔡建强. 2018《CSCO原发性肝癌诊疗指南》解读——外科部分[J]. 肝癌电子杂志,2018,5(3):1-3.
[7] 曾保征,沈世雄,陈林峰. MRI影像学表现与经皮射频消融治疗肝癌疗效的关系[J]. 中国CT和MRI杂志,2021,19(1):129-131.
[8] 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.
[9] 韦云云,覃云英,廖海,等. MRI联合CA125对MVI阴性肝癌术后复发的预测价值[J]. 临床放射学杂志,2020,39(6):1113-1116.
[10] 潘春燕,李凤菊,陶亚飞,等. MRI扫描联合血清4项肿瘤标志物诊断原发性肝癌的临床价值研究[J]. 现代生物医学进展,2022,22(1):126-130.
[11] 王兴林,郭志伟,黄建儒,等. MRI增强扫描对原发性肝癌患者肝动脉化疗栓塞术后MVI预后的预测价值[J]. 广西医科大学学报,2023,40(12):2043-2050.
[12] 石磊,安梓铭,冯琴. 联合检测血清AFP、AFP-L3％和PIVKA-Ⅱ水平早期诊断和判断原发性肝癌患者预后临床价值探讨[J]. 实用肝脏病杂志,2023,26(3):404-407.
[13] Hsiao C Y, Chen P D, Huang K W. A prospective assessment of the diagnostic value of contrast-enhanced ultrasound, dynamic computed tomography and magnetic resonance imaging for patients with small liver tumors[J]. J Clin Med. 2019,8(9):1353.
[14] 董美衬,白晶,刘海顺,等. 血清GPC3、DCP、GP73及AFP联合检测在原发性肝癌的诊断价值[J]. 标记免疫分析与临床,2022,29(7):1142-1147.
[15] Yang T, Wei H, Chen J, et al. The value of contrast-enhanced magnetic resonance imaging for diagnosis of extrahepatic cholangiocarcinoma[J]. Heliyon. 2023,10(1):e23448.
[16] Wang H T, Li A J, Gao J Y, et al. Diagnostic value of computed tomography and magnetic resonance imaging in ovarian malignant mesothelioma[J]. BMC Med Imaging. 2023,23(1):213.
[17] 王可环,林樟萍,李霞. 血清PIVKA-Ⅱ、AFP、GGT、GGT/ALT检测对早期原发性肝癌的诊断价值[J]. 临床和实验医学杂志,2022,21(14):1555-1558.
[18] 刘国振,陈秀余,张修欢. 血清miR-122-5p,miR-486-5p,AFP及AFP-L3水平联合检测对原发性肝癌的诊断价值[J]. 现代检验医学杂志,2022,37(1):82-87.
[19] 谢石穿,王伟. MRI-DWI信号强度值联合血清AFP、CA125在判断小肝癌分化程度中的应用价值[J]. 实用癌症杂志,2020,35(10):1707-1710.
[20] 蒋永磊,李梦双,单倩,等. 肝硬化伴肝癌患者动态增强MRI影像学特点及评估价值[J]. 临床误诊误治,2023,36(5):38-43.
[21] 周婷,王刚,张骏. MRI扫描联合血清GP73 AFP水平对原发性肝癌诊断效能的影响[J]. 河北医学,2020,26(2):298-302.
[22] 唐亚琴,卿仁强,杨松,等. MRI联合血清ApoB、γ-GT用于原发性肝癌临床价值探讨[J]. 中国CT和MRI杂志,2022,20(1):110-112.
[23] 唐亮,郑晓东,郑佳连. 光谱CT、MRI以及血清相关指标与肿瘤标志物检测在原发性肝癌的诊断价值[J]. 中国医学装备,2021,18(9):62-66.
[24] 古军军,李洪强,张雪松,等. 乙型肝炎相关性肝细胞肝癌的CT和MRI增强影像学表现及其与血清肿瘤标志物相关性研究[J]. 中国医学装备,2022,19(11):60-64.
[25] 游长金,邓娟,崔俐莉. MRI参数联合血清MIF、miR-1203在肝细胞肝癌早期诊断中的价值及与疗效的关系[J]. 中国医师杂志,2021,23(5):734-738,743.