B超联合增强CT对原发性肝癌的诊断价值及其与中医证型的相关性研究

Value of ultrasound combined with contrast-enhanced computed tomography in diagnosis of primary liver cancer and its association with traditional Chinese medicine syndrome types

目的:探究B超联合增强CT对原发性肝癌(简称“肝癌”)的诊断价值及与中医证型的相关性。方法:对83例疑似肝癌患者进行B超、CT及肝穿刺活检。观察肝癌的阳性与阴性例数;计算诊断效能,包括准确率(ACC)、灵敏度(SEN)、特异度(SPE)、阳性预测值(+PV)、阴性预测值(-PV);比较肝郁脾虚证、肝肾阴虚证、脾肾阳虚证、气滞血瘀证、湿热瘀毒证患者的肝脏、脾脏大小,肝左叶的上下径、前后径,肝右叶的最大斜径、前后径,脾脏的长径、后径;测量门静脉(PV)、肝静脉(SV)的内径(D)及平均血流速度(TAMX)、血流量(Q)。结果:83例疑似肝癌患者中,病理检出肝癌阳性70例,B超检出肝癌阳性62例,CT检出肝癌阳性65例,B超联合CT检出肝癌阳性68例。B超联合增强CT诊断肝癌的ACC为90.36%、SEN为92.86%、SPE为76.92%,与单用超声、CT检查比较,差异有统计学意义(P<0.05)。肝郁脾虚证、肝肾阴虚证、脾肾阳虚证、湿热瘀毒证患者的肝左叶上下径,肝郁脾虚证患者的脾脏长径,肝郁脾虚证、肝肾阴虚证、湿热瘀毒证患者的厚径,肝郁脾虚证、肝肾阴虚证、湿热瘀毒证患者的门静脉内径,与气滞血瘀证患者比较,差异均有统计学意义(P<0.05)。结论:B超联合增强CT能提高肝癌的诊断效能,超声特征表现与中医证型具有一定的相关性,为中医证候分型与病情评估、治疗提供了参考依据。

Objective:To investigate the value of ultrasound combined with contrast-enhanced computed tomography(CT)in the diagnosis of primary liver cancer and its association with traditional Chinese medicine(TCM)syndrome types.Methods:Ultrasound,contrast-enhanced CT,and liver biopsy were performed for 83 patients suspected of liver cancer.The number of patients with positive or negative liver cancer was observed;diagnostic efficiency was calculated,including accuracy,sensitivity,specificity,positive predictive value,and negative predictive value;the patients with liver depression and spleen deficiency,liver-kidney Yin deficiency,spleen-kidney Yang deficiency,Qi stagnation and blood stasis syndrome,and damp-heat stasis toxin syndrome were compared in terms of liver/spleen size,the superior-inferior diameter and anteroposterior diameter of the left lobe of the liver,the maximum oblique diameter and anteroposterior diameter of the right lobe of the liver,and the long diameter and anteroposterior diameter of the spleen;diameter(D),time-averaged maximum velocity(TAMX),and blood flow volume(Q)were measured for the portal vein and the hepatic vein.Results:Among the 83 patients suspected of liver cancer,70 had positive liver cancer detected by pathological examination,62 had positive liver cancer detected by ultrasound,65 had positive liver cancer detected by CT,and 68 had positive liver cancer detected by ultrasound combined with CT.Ultrasound combined with CT had an accuracy of 90.36%,a sensitivity of 92.86%,and a specificity of 76.92%in the diagnosis of liver cancer,with a significant difference compared with ultrasound or CT used alone(P<0.05).There was a significant difference in the superior-inferior diameter of the left lobe of the liver between the patients with liver depression and spleen deficiency,liver-kidney Yin deficiency,spleen-kidney Yang deficiency,and damp-heat stasis toxin syndrome and those with Qi stagnation and blood stasis syndrome;there was a significant difference in the long diameter of the spleen between the patients with liver depression and spleen deficiency and those with Qi stagnation and blood stasis syndrome;there was a significant difference in thickness between the patients with liver depression and spleen deficiency,liver-kidney Yin deficiency,and damp-heat stasis toxin syndrome and those with Qi stagnation and blood stasis syndrome;there was a significant difference in the diameter of the portal vein between the patients with liver depression and spleen deficiency,liver-kidney Yin deficiency,and damp-heat stasis toxin syndrome and those with Qi stagnation and blood stasis syndrome(P<0.05).Conclusion:Ultrasound combined with contrast-enhanced CT can improve the diagnostic efficiency of liver cancer,and there is a certain association between ultrasound features and TCM syndrome types,which provides a reference for TCM syndrome typing,disease assessment,and treatment.