注射用全氟丁烷微球超声造影联合血清αL-岩藻糖苷酶和叉头框蛋白A1及簇集蛋白对小肝癌和肝脏局灶性结节增生的鉴别价值

The value of perfluorobutyane for injection contrast-enhanced ultrasound combined with serumαL-fucosidase,forkhead box A1 and clusterin in the differentiation of small hepatocellular carcinoma and focal nodular hyperplasia of the liver

目的探讨注射用全氟丁烷微球超声造影联合血清αL-岩藻糖苷酶(AFU)、叉头框蛋白A1(FOXA1)、簇集蛋白对小肝癌和肝脏局灶性结节增生(FNH)的鉴别价值。方法选取2021年3月至2024年3月新疆维吾尔自治区人民医院收治的264例小肝癌或FNH可疑患者,根据病理检查结果分为小肝癌组(87例)和FNH组(177例)。采用注射用全氟丁烷微球超声造影检查比较相关参数。采用酶联免疫吸附法检测和比较血清AFU、FOXA1、簇集蛋白表达。绘制受试者工作特征曲线分析血清AFU、FOXA1、簇集蛋白对小肝癌及FNH的诊断价值。采用四格表分析注射用全氟丁烷微球超声造影联合血清AFU、FOXA1、簇集蛋白对小肝癌及FNH的鉴别价值。结果小肝癌组对比剂早于周围到达、对比剂灌注缺损、动脉期增强后扩大>10%占比均高于FNH组,Kupffer相有高增强环占比低于FNH组,差异均有统计学意义(均P<0.05)。小肝癌组血清AFU、FOXA1、簇集蛋白水平均高于FNH组[(64±6)U/L比(36±5)U/L,(18.4±2.5)μg/L比(13.3±2.2)μg/L,(120±16)μg/L比(84±14)μg/L],差异均有统计学意义(t=38.944、16.829、18.925,均P<0.001)。受试者工作特征曲线分析结果显示血清AFU、FOXA1、簇集蛋白诊断小肝癌和FNH的曲线下面积为0.895(95%置信区间:0.857~0.934)、0.900(95%置信区间:0.861~0.940)、0.866(95%置信区间:0.820~0.913),三者联合诊断小肝癌和FNH的曲线下面积为0.979(95%置信区间:0.965~0.994)。注射用全氟丁烷微球超声造影检测小肝癌和FNH的准确度高于AFU、FOXA1、簇集蛋白单独检测,略低于四者联合检测。结论注射用全氟丁烷微球超声造影联合血清AFU、FOXA1、簇集蛋白可提高对小肝癌和FNH的鉴别价值。

Objective To explore the value of perfluorobutyane for injection contrast-enhanced ultrasound combined with serumαL-fucosidase(AFU),forkhead box A1(FOXA1)and clusterin in the differentiation of small hepatocellular carcinoma(SHCC)and focal nodular hyperplasia(FNH)of the liver.Methods A total of 264 suspected patients with SHCC or FNH admitted to the People′s Hospital of Xinjiang Uygur Autonomous Region from March 2021 to March 2024 were selected and divided into SHCC group(87 cases)and FNH group(177 cases)according to the results of pathological examination.The perfluorobutyane for injection contrast-enhanced ultrasound was used to compare the related parameters.Enzyme-linked immunosorbent assay was used to detect and compare the expression of serum AFU,FOXA1 and clusterin.The receiver operating characteristic curve was drawn to analyze the diagnostic value of serum AFU,FOXA1 and clusterin for SHCC and FNH.The differential value of perfluorobutane for injection contrast-enhanced ultrasound combined with serum AFU,FOXA1 and clusterin in SHCC and FNH was analyzed by four-grid table.Results The proportion of contrast agent arriving earlier than the surrounding area,contrast agent perfusion defect,and enhancement expansion>10%in arterial phase in the SHCC group were higher than those in the FNH group,and the proportion of high-enhancement rings in Kupffer phase was lower than that in the FNH group(all P<0.05).The serum levels of AFU,FOXA1 and clusterin in SHCC group were higher than those in FNH group[(64±6)U/L vs(36±5)U/L,(18.4±2.5)μg/L vs(13.3±2.2)μg/L,(120±16)μg/L vs(84±14)μg/L](t=38.944,16.829,18.925,all P<0.001).The results of receiver operating characteristic curve analysis showed that the area under the curve of serum AFU,FOXA1 and clusterin in the diagnosis of SHCC and FNH were 0.895(95%confidence interval:0.857-0.934),0.900(95%confidence interval:0.861-0.940)and 0.866(95%confidence interval:0.820-0.913),respectively.The area under the curve of the combination of the three markers for the diagnosis of SHCC and FNH was 0.979(95%confidence interval:0.965-0.994).The accuracy of perfluorobutane for injection contrast-enhanced ultrasound in the detection of SHCC and FNH is higher than that of AFU,FOXA1 and clusterin alone,and slightly lower than that of the combined detection of the four.Conclusion Perfluorobutane for injection contrast-enhanced ultrasound combined with serum AFU,FOXA1 and clusterin can improve the differentiation value of SHCC and FNH.