瞬时弹性成像系统FibroScan联合甲胎蛋白检测对肝细胞肝癌的预测价值

Predictive value of transent elastography system FibroScan combined with alpha fetoprotein detection for hepatic cell carcinoma

目的探讨瞬时弹性成像系统FibroScan联合甲胎蛋白检测对肝细胞肝癌(HCC)的预测价值。方法选取广西医科大学第一附属医院2017年6月至2022年8月收治的肝病患者共247例,将其分为HCC组(73例)、肝硬化组(83例)和慢性病毒性肝炎组(91例)。采用瞬时弹性成像系统FibroScan检测3组患者肝脏硬度值(LSM)。比较3组患者LSM和甲胎蛋白水平。运用受试者工作特征(ROC)曲线分析LSM、甲胎蛋白单独和联合对HCC的预测价值。分析LSM分级与HCC发生率的关系以及LSM水平和HCC肿瘤直径的相关性。结果HCC组LSM、甲胎蛋白水平均高于肝硬化组和慢性病毒性肝炎组[(22.4±17.7)kPa比(14.1±8.5)、(5.9±1.3)kPa,35.67(5.19,546.50)μg/L比4.69(3.02,6.49)、2.54(1.96,4.00)μg/L],肝硬化组均高于慢性病毒性肝炎组(均P<0.001)。LSM联合甲胎蛋白预测HCC的曲线下面积分别大于LSM和甲胎蛋白单独预测(0.904比0.806、0.849,均P<0.05)。LSM联合甲胎蛋白预测HCC的敏感度为73.97%,特异度为88.51%。以8.6 kPa作为截断值,当LSM为8.6、13.6、18.6、23.6、28.6 kPa时,HCC发生率分别为50.00%、57.89%、66.00%、67.57%、75.00%。LSM与HCC患者肿瘤直径呈正相关(r=0.404,P<0.001)。结论LSM升高者HCC发生风险也随之升高;当LSM>18.6 kPa时,应参照高风险人群管理。LSM联合甲胎蛋白预测HCC比LSM或甲胎蛋白单独预测更可靠。

Objective To investigate the predictive value of transent elastography system FibroScan combined with alpha fetoprotein(AFP)detection for hepatic cell carcinoma(HCC).Methods From June 2017 to August 2022,247 patients with liver diseases admitted to the First Affiliated Hospital of Guangxi Medical University were selected.Patients were divided into HCC group(73 cases),cirrhosis group(83 cases)and chronic viral hepatitis group(91 cases).The transent elastography system FibroScan was used to detect the liver stiffness measurement(LSM)in the three groups.The levels of LSM and AFP in the three groups were compared.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of LSM and AFP alone and combination for HCC.The relationship between LSM grade and the incidence of HCC and the correlation between LSM level and HCC tumor diameter were analyzed.Results The levels of LSM and AFP in HCC group were higher than those in cirrhosis group and chronic viral hepatitis group[(22.4±17.7)kPa vs(14.1±8.5),(5.9±1.3)kPa;35.67(5.19,546.50)μg/L vs 4.69(3.02,6.49),2.54(1.96,4.00)μg/L],and those in cirrhosis group were higher than those in chronic viral hepatitis group(all P<0.001).The area under the curve(AUC)of HCC predicted by LSM combined with AFP was greater than that predicted by LSM and AFP alone(0.904 vs 0.806,0.849,both P<0.05).The sensitivity of LSM combined with AFP in the prognosis of HCC was 73.97%and the specificity was 88.51%.Taken 8.6 kPa as the cut⁃off value,when the LSM was 8.6,13.6,18.6,23.6,28.6 kPa,the incidence of HCC was 50.00%,57.89%,66.00%,67.57%,75.00%respectively.LSM was positively correlated with tumor diameter in HCC patients(r=0.404,P<0.001).Conclusions With the increase of LSM,the risk of HCC also increases.As LSM>18.6 kPa,it should refer to high⁃risk population management.LSM combined with AFP is more reliable than LSM or AFP alone.