多层螺旋CT多期增强扫描联合血清AFP、CA199、CA125检测对早期原发性肝癌的诊断价值

Diagnostic value of multi-phase enhanced multi-slice spiral CT scan combined with serum alpha-fetoprotein,carbohydrate antigen-199,carbohydrate antigen-125 detection for early primary liver cancer

目的探讨多层螺旋CT多期增强扫描联合血清甲胎蛋白(AFP)、糖类抗原-199(CA199)、糖类抗原-125(CA125)检测对早期原发性肝癌的诊断价值。方法回顾性分析2018年1月至2021年1月在南海区第四人民医院治疗的60例原发性肝癌患者的临床资料(肝癌组),另选择同期治疗的良性肝病患者50例及体检的健康者50例作为良性肝病组和健康组。肝癌与良性肝病患者均接受多层螺旋CT多期增强扫描,并使用化学发光法检测所有受检者的血清AFP、CA199、CA125水平。比较三组受检者的血清AFP、CA199、CA125水平,肝癌组与良性肝病组多层螺旋CT、AFP、CA199、CA125单独诊断阳性率,并分析多层螺旋CT多期增强扫描、AFP、CA199、CA125检测单独与联合对原发性肝癌诊断效能。结果肝癌组患者的血清AFP、CA199水平分别为(199.04±46.13)ng/mL、(104.53±31.34)U/mL,明显高于良性肝病组的(0.87±0.25)ng/mL、(29.93±8.96)U/mL与健康组的(1.15±0.34)ng/mL、(4.91±1.43)U/mL,差异均有统计学意义(P<0.05);肝癌组患者的血清CA125水平为(138.42±41.51)U/mL,与良性肝病组的(160.03±47.99)U/mL比较差异无统计学意义(P>0.05),但明显高于健康组的(8.24±2.41)U/mL,差异有统计学意义(P<0.05);良性肝病组患者的血清CA199、CA125水平明显高于健康组,差异均有统计学意义(P<0.05);肝癌组患者多层螺旋CT、AFP、CA199阳性检出率分别为91.67%、80.00%、51.67%,明显高于良性肝病组的4.00%、6.00%、6.00%,差异均有统计学意义(P<0.05);肝癌组患者CA125阳性检出率为41.67%,与良性肝病组的36.00%比较差异无统计学意义(P>0.05);多层螺旋CT、AFP、CA199、CA125联合诊断早期原发性肝癌的准确度、灵敏度分别为96.36%、95.00%,明显高于多层螺旋CT的89.09%、83.33%,AFP的86.36%、80.00%,CA199的70.91%、51.67%,CA125的51.82%、41.67%,差异均有统计学意义(P<0.05);多层螺旋CT、AFP、CA199、CA125联合诊断的漏诊率为5.00%,明显低于多层螺旋CT的16.67%,AFP的20.00%,CA199的48.33%,CA125的58.33%,差异均有统计学意义(P<0.05)。结论多层螺旋CT多期增强扫描联合血清AFP、CA199、CA125检测对早期原发性肝癌诊断有较高的灵敏度、准确度,漏诊率较低,可以有效指导临床诊断。

Objective To explore the value of multi-phase enhanced multi-slice spiral CT scan combined with serum alpha-fetoprotein(AFP),carbohydrate antigen-199(CA199),and carbohydrate antigen-125(CA125)in the diagnosis of early primary liver cancer.Methods The clinical data of 60 patients with primary liver cancer treated in the Fourth People’s Hospital of Nanhai District of Foshan from January 2018 to January 2021 were retrospectively analyzed(liver cancer group).Another 50 patients with benign liver disease treated during the same period and 50 cases of healthy people undergoing physical examination were regarded as the benign liver disease group and the healthy group.All patients with liver cancer and benign liver disease received multi-phase enhanced multi-slice spiral CT scanning,and the serum AFP,CA199 and CA125 levels of all subjects were detected by chemiluminescence method.The serum levels of AFP,CA199,and CA125 were compared among the three groups,and the positive rates of multi-slice spiral CT,AFP,CA199,and CA125 alone in the liver cancer group and the benign liver disease group were analyzed.The diagnostic efficacy of multi-phase enhanced multi-slice spiral CT,AFP,CA199,CA125 detection alone and combined detection for primary liver cancer were analyzed.Results The serum AFP and CA199 levels in the liver cancer group were(199.04±46.13)ng/mL and(104.53±31.34)U/m L,which were significantly higher than(0.87±0.25)ng/m L and(29.93±8.96)U/m L in the benign liver disease group and(1.15±0.34)ng/mL and(4.91±1.43)U/mL in the healthy group(P<0.05).The serum CA125 level in the liver cancer group was(138.42±41.51)U,which showed no statistically significant difference with(160.03±47.99)U/mL in the benign liver disease group(P>0.05),but was significantly higher than(8.24±2.41)U/m L in the healthy group(P<0.05).The levels of serum CA199 and CA125 in the benign liver disease group were significantly higher than those in the healthy group,and the difference were statistically significant(P<0.05).The positive detection rates of multi-slice spiral CT,AFP,and CA199 in the liver cancer group were 91.67%,80.00%,and 51.67%,which were significantly higher than 4.00%,6.00%,6.00% in the benign liver disease group(P<0.05).The positive detection rate of CA125 in the liver cancer group was 41.67%,which showed no statistically significant difference with 36.00% in the benign liver disease group(P>0.05).The accuracy and sensitivity of combined detection of multi-slice spiral CT,AFP,CA199 and CA125 in the diagnosis of early primary liver cancer were 96.36% and 95.00%,which were significantly higher than 89.09% and 83.33% of multi-slice spiral CT,86.36%,80.00% of AFP,70.91% and 51.67% of CA199,51.82% and 41.67% of CA125(P<0.05).The missed diagnosis rate of combined detection was 5.00%,which was significantly lower than 16.67% of multi-slice spiral CT,20.00% of AFP,48.33% of CA199,and 58.33% of CA125(P<0.05).Conclusion Multi-phase enhanced multi-slice spiral CT combined with serum AFP,CA199,CA125 detection has high sensitivity and accuracy in the diagnosis of early primary liver cancer,with low rate of missed diagnosis,which can effectively guide clinical diagnosis.