超声造影联合血清SP70、AFP、PIVKA-Ⅱ诊断早期肝癌的价值观察

摘要/Abstract

摘要： 目的探讨超声造影(CEUS)联合肿瘤特异性蛋白70(SP70)、甲胎蛋白(AFP)及异常凝血酶原(PIVKA-Ⅱ)在早期肝细胞癌(HCC)诊断中的应用价值。方法选择2018年5月至2024年8月在洛川县医院确诊的早期HCC患者80例为HCC组,另选80例肝脏良性病变患者为良性组。对两组患者的CEUS特征参数进行分析,并检测SP70、AFP和PIVKA-Ⅱ的血清水平,评估这些指标在早期HCC诊断中的灵敏度和特异度。结果 HCC组在单发病灶、边界不清晰、病灶形态不规则以及病灶血供丰富比例分别为85%、28.75%、25.00%、23.75%,均高于良性组的67.50%、2.50%、7.50%、12.50%(P<0.05)。在CEUS门脉期和延迟期,HCC组呈现等增强或低增强的患者比例分别为83.75%、87.50%,均高于良性组的48.75%、51.25%(P<0.05)。血清学指标方面,HCC组的SP70、AFP、PIVKA-Ⅱ水平分别为(11.23±4.58)ng/mL、(44.64±18.28)ng/mL、(83.45±36.34)mAU/mL,均高于良性组的(8.68±3.74)ng/mL、(15.27±6.63)ng/mL、(44.23±19.29)mAU/mL(P<0.05)。ROC曲线结果显示,CEUS、SP70、AFP和PIVKA-Ⅱ对早期肝癌的诊断灵敏度分别为75.0%、41.2%、93.8%和75.0%,特异度分别为77.5%、92.5%、91.2%和87.5%,AUC分别为0.788、0.658、0.951和0.838。而当CEUS联合SP70、AFP和PIVKA-Ⅱ进行预测时,灵敏度和特异度分别提升至91.2%和98.8%,AUC值则达到0.983。结论 CEUS联合SP70、AFP和PIVKA-Ⅱ检测在早期肝癌的诊断中具有较高的灵敏度和特异度,有助于提高HCC的早期诊断率,值得在临床推广应用。

关键词: 超声造影, 肿瘤特异性蛋白70, 甲胎蛋白, 异常凝血酶原, 肝细胞癌

Abstract: Objective To explore the value of contrast-enhanced ultrasound (CEUS) combined with tumor-specific protein 70 (SP70), alpha-fetoprotein (AFP), and prothrombin induced by vitamin K absence Ⅱ (PIVKA-Ⅱ) in the diagnosis of early hepatocellular carcinoma (HCC). Methods Eighty patients diagnosed with early HCC in Luochuan County, People's Hospital from May 2018 to August 2024 were selected as the HCC group, and 80 patients with benign liver lesions were selected as the benign group. CEUS parameters were analyzed for both groups, and serum levels of SP70, AFP, and PIVKA-Ⅱ were measured. The sensitivity and specificity of these indicators in diagnosing early HCC were evaluated. Results In the HCC group, the proportions of patients with single lesions, unclear boundaries, irregular lesion shapes, and abundant blood supply were 85.00%, 28.75%, 25.00%, and 23.75%, respectively, which were significantly higher than those in the benign group (67.50%, 2.50%, 7.50%, and 12.50%, P<0.05). During the portal and delayed phases of CEUS, the proportions of patients with iso-enhancement or hypo-enhancement in the HCC group were 83.75% and 87.50%, respectively, also significantly higher than in the benign group (48.75% and 51.25%, P<0.05). In terms of serum markers, SP70, AFP, and PIVKA-Ⅱ levels in the HCC group were 11.23±4.58 ng/mL, 44.64±18.28 ng/mL, and 83.45±36.34 mAU/mL, respectively, which were higher than those of 8.68±3.74 ng/mL, 15.27±6.63 ng/mL, and 44.23±19.29 mAU/mL in the benign group (P<0.05). ROC curve analysis showed that the sensitivity of CEUS, SP70, AFP, and PIVKA-Ⅱ for early HCC diagnosis was 75.0%, 41.2%, 93.8%, and 75.0%, and specificity was 77.5%, 92.5%, 91.2%, and 87.5%, with AUC values of 0.788, 0.658, 0.951, and 0.838, respectively. When CEUS was combined with serum levels of SP70, AFP, and PIVKA-Ⅱ, the sensitivity and specificity increased to 91.2% and 98.8%, respectively, with an AUC of 0.983. Conclusion CEUS combined with SP70, AFP, and PIVKA-Ⅱ detection exhibits high sensitivity and specificity in the diagnosis of early HCC, which may facilitate early diagnosis and has potential for clinical application.

Key words: Contrast-enhanced ultrasound, Tumor-specific protein 70, Alpha-fetoprotein, Prothrombin induced by vitamin K absence Ⅱ, Hepatocellular carcinoma

李晓艳, 张景芳, 王春萍, 周平安. 超声造影联合血清SP70、AFP、PIVKA-Ⅱ诊断早期肝癌的价值观察[J]. 肝脏, 2025, 30(4): 462-466.

LI Xiao-yan, ZHANG Jing-fang, WANG Chun-ping, ZHOU Ping-an. Diagnostic value of contrast-enhanced ultrasound combined with serum SP70, AFP, and PIVKA-Ⅱ in the diagnosis of early hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(4): 462-466.

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参考文献

[1] 顾丽慧, 王明达, 邢昊, 等. 血小板在肝细胞癌恶性进展中的作用[J]. 中华消化外科杂志,2023,22(2):286-292.
[2] 黄梦, 钱晓寒, 杨丽华. 环状RNA应用于肝细胞癌无创早期诊断的研究进展[J]. 肝脏,2023,28(6):720-724.
[3] 李健康, 李思柔. 肝癌术后早期复发监测的研究进展[J]. 医学研究生学报,2023,36(1):106-112.
[4] 骆云皓, 黄秋韵, 栗航, 等. 示卓安超声造影在肝细胞癌诊疗中的应用及进展[J]. 中华超声影像学杂志,2024,33(8):731-736.
[5] 刘晓婷, 刘洋, 张换勤, 等. 肿瘤标志物在肝细胞癌诊断及预后中的应用[J]. 国际肿瘤学杂志,2022,49(6):371-375.
[6] Wang L, Shi H, Wei J, et al. SP70 is a novel biomarker of hepatocellular carcinoma[J]. Front Oncol, 2023, 13: 1149397.
[7] 乔轩, 杨勇, 许涛, 等. AFP、AFP-L3及PIVKA-Ⅱ单独及联合检测在早期原发性肝细胞癌中的诊断价值[J]. 医学研究杂志,2023,52(7):51-55.
[8] Zhou J, Sun H C, Wang Z, et al. Guidelines for diagnosis and treatment of primary liver cancer in China (2017 Edition)[J]. Liver cancer, 2018, 7(3): 235-260.
[9] Llovet J M, Castet F, Heikenwalder M, et al. Immunotherapies for hepatocellular carcinoma[J]. Nat Rev Clin Oncol, 2022, 19(3): 151-172.
[10] Ganesan P, Kulik L M. Hepatocellular carcinoma: new developments[J]. Clin Liver Dis, 2023, 27(1): 85-102.
[11] Guan M C, Wang M D, Liu S Y, et al. Early diagnosis and therapeutic strategies for hepatocellular carcinoma: from bench to bedside[J]. World J Gastro Oncol, 2021, 13(4): 197-215.
[12] Marschner C A, Zhang L, Schwarze V, et al. The diagnostic value of contrast-enhanced ultrasound (CEUS) for assessing hepatocellular carcinoma compared to histopathology; a retrospective single-center analysis of 119 patients[J]. Clin Hemorheol Micro, 2020, 76(4): 453-458.
[13] Strobel D, Jesper D, Jung E M, et al. Real-life assessment of standardized contrast-enhanced ultrasound (CEUS) and CEUS algorithms (CEUS LI-RADS/ESCULAP) in hepatic nodules in cirrhotic patients. A prospective multicenter study[J]. Eur Radiol, 2021, 31(10): 7614-7625.
[14] Zuo D, Yang K, Wu S. Diagnostic performance of intravascular perfusion based contrast-enhanced ultrasound LI-RADS in the evaluation of hepatocellular carcinoma[J]. Clin Hemorheol Micro, 2021, 78(4): 429-437.
[15] Mak L Y. Disease modifiers and novel markers in hepatitis B virus-related hepatocellular carcinoma[J]. Liver Cancer, 2024, 24(2): 145-154.
[16] Toan B N, Tan C K, Hasan I, et al. Utility of combining PIVKA-Ⅱ and AFP in the surveillance and monitoring of hepatocellular carcinoma in the Asia-Pacific region[J]. Clin Mol Hepatol, 2023, 29(2): 277-292.
[17] Tian S, Chen Y, Zhang Y, et al. Clinical value of serum AFP and PIVKA-Ⅱ for diagnosis, treatment and prognosis of hepatocellular carcinoma[J]. J Clin Lab Anal, 2023, 37(1): e24823.
[18] Schwarze V, Marschner C, Völckers W, et al. The diagnostic performance of contrast-enhanced ultrasound (CEUS) for evaluating hepatocellular carcinoma (HCC) juxtaposed to MRI findings; a retrospective single-center analysis of 292 patients[J]. Clin Hemorheol Micro, 2020, 76(2): 155-160.
[19] Meitner-Schellhaas B, Jesper D, Goertz R S, et al. Washout appearance of hepatocellular carcinomas using standardized contrast-enhanced ultrasound (CEUS) including an extended late phase observation-Real-world data from the prospective multicentre DEGUM study[J]. Clin Hemorheol Micro, 2023, 84(4): 413-424.
[20] Saito A, Yamamoto M, Katagiri S, et al. Early hemodynamics of hepatocellular carcinoma using contrast-enhanced ultrasound with Sonazoid: focus on the pure arterial and early portal phases[J]. GLOB HLTH MED-JPN, 2020, 2(5): 319-327.