多层螺旋CT及相关肿瘤标志物水平检测对肝细胞癌的诊断价值

Diagnostic value of multi-slice spiral CT and the levels of tumor markers in hepatocellular carcinoma

目的:探讨肝细胞癌(HCC)多层螺旋CT(MSCT)影像特点及肿瘤标志物水平变化。方法:以本院2013年3月至2016年3月就诊的115例肝脏病变患者为研究对象,病理证实肝细胞癌60例,良性病变55例。所有患者均接受MSCT检查及血清高尔基体蛋白73(GP73)、磷脂酰肌醇蛋白聚糖3(GPC3)水平检测,观察HCC患者CT表现,以病理结果为金标准,分析MSCT诊断肝细胞癌敏感度、特异度及准确度,同时比较良恶性病变血清GP73、GPC3水平及其阳性检出率。结果:HCC患者血清GP73、GPC3水平均显著高于良性病变(P<0.05),血清GP73、GPC3单独及联合检测阳性检出率均显著高于良性病变(P<0.05)。MSCT平扫图像多为低密度,增强扫描动脉期多为高密度影,门脉期多为低密度影或以低密度影为主,延迟期多为低密度影。MSCT对HCC诊断敏感度、特异度、准确度分别为85.00%、90.91%、87.83%。结论:MSCT对HCC特征清晰显示,诊断准确率较高,血清GP73、GPC3也可作为HCC诊断重要辅助手段,两者联合检测能有效提高HCC阳性检出率。

Objective： To investigate the mult i - slice spiral CT（ MSCT） imaging findings of hepatocellular carcinoma（HCC）and changes of levels of tumor markers. Methods： 115 patients with hepatopathy who were admitted in our hospital from March 2013 to March 2016 were selected as study subjects. Pathology confirmed that there were 60 cases of HCC and 55 cases of benign lesions. All patients underwent MSCT examination and detection of serum Golgi protein 73（GP73）and glypican -3（GPC3）. The CT findings of patients with HCC were observed. With the pathological re-sults as the golden standard,the sensitivity,specificity and accuracy of MSCT in the diagnosis of HCC were analyzed. The GP73 and GPC3 levels were compared between benign and malignant lesions. Results： The levels o f serum GP73 and GPC3 in patients with HCC were significantly higher than those in patients with benign lesions（P 〈0. 05） ,and the positive rates of serum GP73 and GPC3 alone and combined detection were significantly higher than those in be-nign lesions（P 〈0. 05） . MSCT scan image mainly showed low density, and enhanced scan showed that there mainly was high density in arterial phase,low density in portal phase and low density in delayed phase. The sensitivity,speci-ficity and accuracy of MSCT in the diagnosis of HCC were 85. 00% ,90. 91% and 87. 83% , respectively. Conclu-sion： MSCT can clearly show the characteristics of HCC, and the diagnostic accuracy rate is high. Serum GP73 and GPC3 also can be used as important supplementary means for diagnosis of HCC, and combined detection of the two can improve the positive detection rates of HCC.