超声造影联合血清sTIM-3、YKL-40水平在胆囊病灶良恶性鉴别诊断中的价值

摘要/Abstract

摘要： 目的评估超声造影结合血清可溶性T细胞免疫球蛋白黏蛋白3(sTIM-3)、人软骨糖蛋白39(YKL-40)水平在胆囊病灶良恶性鉴别诊断中的价值。方法选取河北省邯郸市人民医院2021年5月到2023年11月收治的320例胆囊占位病变患者,根据术后病理结果分为良性组262例和恶性组58例。所有患者接受常规超声检查、超声造影及血清sTIM-3与YKL-40水平检测,比较两组患者的临床特征及检测指标。结果二维超声显示,恶性组病变形状不规则、病灶数量多发及浸润肝脏比例分别为74.14%、81.03%、43.10%,高于良性组的23.28%、46.56%、0.00%,差异有统计学意义(P<0.05),两组合并胆囊结石比较,差异无统计学意义(P>0.05)。超声造影显示,两组动脉期增强水平比较,差异无统计学意义(P>0.05)。分布特征方面,良性组表现出均匀分布的比例为73.66%,高于恶性组的56.90%(P<0.05)。静脉期增强水平方面,恶性组低增强的比例为82.76%,高于良性组的7.25%(P<0.05)。胆囊壁完整性方面,良性组的胆囊壁完整性比例为95.80%,高于恶性组的53.45%(P<0.05)。病灶基底方面,良性组的宽型病灶比例为46.95%,低于恶性组的96.55%(P<0.05)。恶性组血清sTIM-3与YKL-40水平分别为(3.20±1.18)ng/mL、(247.48±54.85)ng/mL高于良性组的(1.71±0.52)ng/mL、(168.80±34.19)ng/mL(P<0.01)。ROC曲线分析表明,超声造影对胆囊病灶良恶性的诊断灵敏度为82.8%,特异度为92.7%,AUC值为0.898。血清sTIM-3的灵敏度为81.0%,特异度为88.2%,AUC值为0.883。YKL-40的灵敏度为82.8%,特异度为84.0%,AUC值为0.891。当超声造影与sTIM-3和YKL-40联合使用时,灵敏度提高至91.4%,特异度达到98.1%,AUC值为0.966。结论超声造影联合血清sTIM-3和YKL-40水平检测能够显著提高胆囊病灶良恶性鉴别的准确性,为临床提供更为可靠的参考依据。

关键词: 超声造影, 胆囊病灶, 可溶性T细胞免疫球蛋白黏蛋白3, 人软骨糖蛋白39, 良恶性鉴别

Abstract: Objective To evaluate the diagnostic value of contrast-enhanced ultrasound combined with serum soluble T cell immunoglobulin mucin-3 (sTIM-3) and YKL-40 levels in differentiating malignant and benign gallbladder lesions. Methods A total of 320 patients with gallbladder occupying lesions admitted to Handan People's Hospital from May 2021 to November 2023 were selected. According to postoperative pathological results, patients were divided into a benign group (262 cases) and a malignant group (58 cases). All patients underwent routine and contrast-enhanced ultrasound examinations, and serum sTIM-3 and YKL-40 level testing. Clinical characteristics and detection indicators were compared between the two groups. Results Two-dimensional ultrasound showed that the proportions of irregular lesion shapes, multiple lesion numbers, and liver infiltration in the malignant group were 74.14%, 81.03%, and 43.10%, respectively, which were higher than those in the benign group (23.28% , 46.56%, and 0.00%, respectively) (P<0.05). There was no significant difference in the comparison of combined gallbladder stones between the two groups (P>0.05). Contrast-enhanced ultrasound showed that there was no significant difference in the enhancement levels during the arterial phase between the two groups (P>0.05). In terms of distribution characteristics, the proportion of uniform distribution in the benign group was 73.66% , which was higher than that in the malignant group (56.90%) (P<0.05). In terms of the enhancement level during the venous phase, the proportion of low-level enhancement in the malignant group was 82.76%, which was higher than that in the benign group (7.25%) (P<0.05). In terms of the integrity of the gallbladder wall, the proportion of the integrity of the gallbladder wall in the benign group was 95.80% , which was higher than that in the malignant group (53.45% ) (P<0.05). In terms of the lesion base, the proportion of wide-type lesions in the benign group was 46.95% , which was lower than that in the malignant group (96.55%)(P<0.05). The serum sTIM-3 and YKL-40 levels in the malignant group were (3.20 ± 1.18) ng/mL and (247.48 ± 54.85) ng/mL, respectively, which were higher than those in the benign group [(1.71 ± 0.52) ng/mL and (168.80 ± 34.19) ng/mL, respectively] (P<0.01). ROC curve analysis showed that the sensitivity of contrast-enhanced ultrasound for diagnosing malignant and benign gallbladder lesions was 82.8%, with a specificity of 92.7% and an AUC of 0.898. The sensitivity for serum sTIM-3 was 81.0%, specificity 88.2%, and AUC 0.883. For YKL-40, the sensitivity was 82.8%, specificity 84.0%, and AUC 0.891. When combining contrast-enhanced ultrasound with sTIM-3 and YKL-40, sensitivity increased to 91.4%, specificity reached 98.1%, and the AUC value was 0.966. Conclusion The detection of contrast-enhanced ultrasound combined with serum sTIM-3 and YKL-40 levels can significantly improve the accuracy of differentiating between benign and malignant gallbladder lesions, providing a reliable reference for clinical practice.

Key words: Contrast-enhanced ultrasound, Gallbladder lesions, Soluble T cell immunoglobulin mucin-3, YKL-40, Differentiation of benign and malignant lesions

胡丽军, 连倩倩. 超声造影联合血清sTIM-3、YKL-40水平在胆囊病灶良恶性鉴别诊断中的价值[J]. 肝脏, 2025, 30(5): 722-726.

HU Li-jun, LIAN Qian-qian. The value of contrast-enhanced ultrasound combined with serum sTIM-3 and YKL-40 levels in differentiating malignant and benign gallbladder lesions[J]. Chinese Hepatolgy, 2025, 30(5): 722-726.

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