有无肝硬化肝细胞癌患者的影像特征及实验室检查指标间的比较研究

Comparative research of radiological features and laboratory indexes in hepatocellular carcinoma patients with and without cirrhosis

目的:比较有、无肝硬化肝细胞癌(HCC)患者的CT特征、测量参数、各期扫描CT值及实验室检查指标的差异,以提高HCC的诊断准确率。方法:回顾性收集经病理证实且未经治疗的52例HCC患者的CT及实验室检查资料。分析CT特征,并测量门静脉最大径、肝脏和病灶体积、最大截面面积及各期扫描CT值。52例根据是否合并肝硬化分为合并肝硬化组24例和无肝硬化组28例。2组计数资料比较行χ^(2)检验,正态分布和非正态分布的计量资料分别行独立样本t检验和Mann-WhitneyU检验。CT特征、测量参数与实验室检查指标间行Spearman相关分析。结果:2组年龄和性别差异均无统计学意义(P=0.073,0.463);2组胆碱酯酶、直接胆红素、间接胆红素和AFP水平差异均有统计学意义(均P<0.05)。2组病灶CT征象、肝脏和病灶体积、最大截面面积差异均无统计学意义(均P>0.05),肝实质门静脉期和病灶平扫CT值、腹水和/或脾大情况及门静脉最大径差异均有统计学意义(均P<0.05)。HCC病灶体积与病灶坏死、形状、转移情况、肝脏体积及部分血清酶水平均呈正相关,与病灶平扫、门静脉期和延迟期CT值呈负相关。肝硬化与腹水和/或脾大、门静脉最大径、直接胆红素、间接胆红素及AFP呈正相关。结论:HCC合并肝硬化组与无肝硬化组间在CT特征、测量参数等方面差异不明显;合并肝硬化组多发生腹水及门脉高压表现;HCC病灶大小与实验室检查指标密切相关。

Objective:To compare and analyze the CT features,measurement parameters,CT values and laboratory indexes of hepatocellular carcinoma(HCC)patients with and without liver cirrhosis.Methods:A retrospective collection of CT data and laboratory indexes from 52 pathological confirmed and untreated HCC patients was made.The CT features were analyzed,and the maximum diameter of portal vein,the volume,the maximum cross-sectional area,CT values of the liver and lesions were measured.52 patients were divided into HCC with cirrhosis group(24 cases)and HCC without cirrhosis group(28 case).The statistical analysis was performed by using Chi-squared test,independent sample t test or Mann-Whitney U test appropriately.The correlations among CT features,measurement parameters and laboratory indexes were analyzed by Spearman correlation test.Results:There were no significant differences in age or gender between the two groups(P=0.073,0.463).There were significant differences in levels of cholinesterase,direct bilirubin,indirect bilirubin and AFP between the two groups(all P<0.05).There were no significant differences in CT features of lesions,the volume and the maximum cross-sectional area of the liver and lesions(all P>0.05).There were significant differences in CT value of hepatic parenchyma in portal vein phase,CT value of lesions in plain scan,ascites and/or splenomegaly situation,the maximum diameter of portal vein between the two groups(all P<0.05).The volume of HCC lesions was positively correlated with necrosis,morphology,metastasis,liver volume and some serum enzyme levels,but negatively correlated with lesion CT values in plain scan,portal vein and delayed phases.In addition,liver cirrhosis was positively correlated with ascites and/or splenomegaly situation,the maximum diameter of portal vein,direct and indirect bilirubin levels and AFP levels.Conclusions:There are no significant differences in CT features or measurement parameters between HCC with cirrhosis and HCC without cirrhosis.Ascites and portal hypertension are more common in HCC with cirrhosis.The size of HCC lesion is closely related to laboratory indexes.