文章摘要
李树芸,王宗盛,徐春玲.增强CT联合肿瘤标志物检测在肝癌诊断及预后中的应用价值[J].南京医科大学学报,2020,(11):1628~1632
增强CT联合肿瘤标志物检测在肝癌诊断及预后中的应用价值
Application value of enhanced CT combined with tumor markers in diagnosis and prognosis of hepatocellular carcinoma
投稿时间:2019-08-02  
DOI:10.7655/NYDXBNS20201110
中文关键词: CT  诊断  肝细胞癌  肿瘤标志物
英文关键词: CT  diagnosis  HCC  tumor markers
基金项目:江苏省卫生计生委医学科研课题指导性项目(Z201704)
作者单位
李树芸 徐州医科大学附属连云港医院影像科 江苏 连云港 222061 
王宗盛 徐州医科大学附属连云港医院影像科 江苏 连云港 222061 
徐春玲 徐州医科大学附属连云港医院影像科 江苏 连云港 222061 
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中文摘要:
      目的:探讨CT联合肿瘤标志物(tumor markers,TM)在肝细胞癌(hepatocellular carcinoma,HCC)诊断和预后中的应用价值。方法:选择62例HCC患者作为研究对象,所有患者均行肝部分切除术。另外,选取65例健康受试者作为对照组。收集血液样本,通过放射免疫法测定血清甲胎蛋白(alpha fetoprotein,AFP)、糖类抗原19?9(carbohydrate antigen 19?9,CA19?9)和癌胚抗原(carcinoembryonic antigen,CEA)。 通过病理学检查研究血清TM水平与临床病理学特征之间的相关性。所有HCC患者还进行腹部增强CT扫描,探讨其影像学特征。利用受试者工作特征(receiver operating characteristic,ROC)曲线分析单个TM检测、TM组合检测、TM组合检测联合CT检查的诊断效能。结果:HCC患者血清AFP、CA19?9和CEA水平明显高于对照组(P < 0.05)。与高分化和无远处转移的患者相比,低分化和有远处转移的患者具有更高水平的AFP、CA19?9和CEA(P < 0.05)。在不同年龄、性别和临床分期的HCC患者中,TM水平差异没有统计学意义(P > 0.05)。 ROC分析显示,与3种TM的组合检测相比,单个检测血清AFP、CEA或CA19?9具有较低的特异度和灵敏度(P < 0.05)。TM组合检测联合CT检查可达到95.71%的特异度和87.47%的灵敏度,优于3种TM组合检测(P < 0.05)。8例HCC患者术后6个月内复发。与术前相比,复发患者血清AFP、CA19?9和CEA水平显著升高,且高于未复发的患者(P < 0.05)。结论:血清AFP、CA19?9和CEA组合检测联合CT检查可以克服单个TM检测的不足,避免误诊和漏诊,显著提高HCC的阳性检出率。
英文摘要:
      Objective:This study aims to investigate enhanced CT combined with tumor markers (TM)in diagnosis and prognosis of hepatocellular carcinoma(HCC). Methods:Total 62 HCC patients were selected and all of them had undergone hepatectomy. In addition,65 healthy subjects were selected as control. Blood samples were collected preoperatively from all subjects,and serum alpha fetoprotein(AFP),carbohydrate antigen 19?9(CA19?9)and carcinoembryonic antigen(CEA)levels were determined by radioimmunoassay. The correlation between serum TM levels and clinicopathological features was investigated by pathological examination. The imaging features of HCC were explored by spiral enhanced CT scanning. The diagnostic effiency of single TM,combined TMs,combined TMs and CT was analyzed by receiver operating characteristic(ROC) curves. Results:The levels of serum AFP,CA19?9 and CEA in HCC patients were significantly higher than those in controls(P < 0.05). Patients with low differentiation and distant metastasis lesions had higher levels of AFP,CA19?9 and CEA(P < 0.05),compared with patients with high differentiation and no distant metastasis lesions. There were no significant differences in TM levels in HCC patients with different age,gender and clinical stages(P > 0.05). The ROC analysis showed that the detection of single serum AFP,CEA or CA19?9 had lower specificity and sensitivity compared with the combined detection of three TMs(P < 0.05). The combined detection of TMs and CT examination could achieve a specificity of 95.71% and a sensitivity of 87.47%,superior to the detection of the TMs(P < 0.05). Eight HCC patients relapsed within 6 months after operation. Compared with those before operation,the levels of serum AFP,CA19?9 and CEA in the relapsed patients were increased significantly,and the TM levels were higher than those in patients without relapse(P < 0.05). Conclusion:The detection of serum AFP,CA19?9 and CEA combined with CT can overcome the deficiency of single detection,avoid misdiagnosis,and significantly increase the positive detection rate of HCC。
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