摘要
目的探讨超声造影血流灌注参数对肝细胞肝癌病理分化程度的鉴别价值。方法采用回顾性分析,收集2022年5月至2024年3月在安康市中医医院诊治的134例肝细胞肝癌患者的临床资料,其中男96例、女38例,年龄(59.72±10.85)岁。所有患者在治疗前均行超声造影检查,记录血流灌注参数(始增时间、达峰时间、始退时间、峰值增强时间、廓清时间、始增强度、峰值强度、平均血流密度),并经病理检查结果明确组织分化程度。比较不同分化程度肝细胞肝癌患者超声造影血流灌注参数,采用受试者操作特征曲线(ROC)分析超声造影血流灌注参数对肝细胞肝癌病理分化程度的鉴别价值。统计学方法采用非参数秩和检验、单因素方差分析。结果134例肝细胞肝癌患者中,高分化31例、中分化59例、低分化44例。不同分化程度肝细胞肝癌患者的始增时间、始增强度、峰值强度比较差异均无统计学意义(均P>0.05)。高分化、中分化、低分化肝细胞肝癌患者的达峰时间[(38.29±8.19)s、(28.03±6.69)s、(23.55±3.61)s]、峰值增强时间[21.00(19.50,24.50)s、14.00(10.00,18.50)s、10.50(9.00,12.25)s]、始退时间[(131.97±37.10)s、(79.44±25.98)s、(56.11±18.59)s]、廓清时间[(76.45±23.58)s、(47.90±14.91)s、(33.05±10.32)s]、平均血流密度[(0.36±0.10)、(0.57±0.15)、(0.78±0.22)]比较,差异均有统计学意义(均P<0.001);达峰时间、峰值增强时间、始退时间、廓清时间在高分化、中分化、低分化患者中均依次减短,平均血流密度依次增加(均P<0.05)。ROC分析结果显示,达峰时间、峰值增强时间、始退时间、廓清时间、平均血流密度鉴别肝细胞肝癌病理分化程度的曲线下面积(AUC)分别为0.767、0.778、0.830、0.824、0.828,5项联合诊断时的AUC(0.920)高于单项诊断(均P<0.05)。结论超声造影血流灌注参数中达峰时间、峰值增强时间、始退时间、廓清时间、平均血流密度均可用于鉴别肝细胞肝癌病理分化程度,5项参数联合鉴别价值更高。
Objective To explore the value of contrast-enhanced ultrasound blood flow perfusion parameters in distinguishing the pathological differentiation degrees of hepatocellular carcinoma.Methods A retrospective analysis was conducted on the clinical data of 134 patients with hepatocellular carcinoma treated in Ankang Traditional Chinese Medicine Hospital from May 2022 to March 2024.There were 96 males and 38 females who were(59.72±10.85)years old.All the patients underwent contrast-enhanced ultrasound examination before the treatment.The blood flow perfusion parameters(initial increase time,peak time,initial retreat time,peak enhancement time,clearance time,initial increase intensity,peak intensity,and average blood flow density)were recorded.The degree of tissue differentiation was determined based on the pathological examination results.The blood flow perfusion parameters of contrast-enhanced ultrasound in the patients with hepatocellular carcinoma of different differentiation degrees were compared,and the value of contrast-enhanced ultrasound blood flow perfusion parameters in distinguishing the pathological differentiation degrees of hepatocellular carcinoma was analyzed using receiver operating characteristic curves(ROC).The statistical methods included nonparametric rank sum test and one-way analysis of variance.Results Among the 134 patients,31 were highly differentiated,59 were moderately differentiated,and 44 were poorly differentiated.There were no statistical differences in initial increase time,initial increase intensity,and peak intensity between the patients with hepatocellular carcinoma of different differentiation degrees(all P>0.05).There were statistical differences in the peak time[(38.29±8.19)s,(28.03±6.69)s,and(23.55±3.61)s],peak enhancement time[21.00(19.50,24.50)s,14.00(10.00,18.50)s,and 10.50(9.00,12.25)s],initial retreat time[(131.97±37.10)s,(79.44±25.98)s,and(56.11±18.59)s],clearance time[(76.45±23.58)s,(47.90±14.91)s,and(33.05±10.32)s],and average blood flow density(0.36±0.10,0.57±0.15,and 0.78±0.22)between the patients of high,moderate,and poor differentiation(all P<0.05).The peak time,peak enhancement time,initial retreat time,and clearance time decreased from the patients of high differentiation to the patients of moderate differentiation,and to the patients of poor differentiation,while the average blood flow density increased(P<0.05).The ROC analysis results showed that the areas under the curves for distinguishing the pathological differentiation degrees of hepatocellular carcinoma based on peak time,peak enhancement time,initial retreat time,clearance time,and average blood flow density were 0.767,0.778,0.830,0.824,and 0.828,respectively.The area under the curve of the combined diagnosis of the five factors(0.920)was higher than that of the single diagnosis(all P<0.05).Conclusion The peak time,peak enhancement time,initial retreat time,clearance time,and average blood flow density in contrast-enhanced ultrasound perfusion parameters can all be used to differentiate the pathological differentiation degrees of hepatocellular carcinoma,and the combined value of these five parameters is higher.
作者
胡筠
崔翔
王晓玲
张家兰
Hu Yun;Cui Xiang;Wang Xiaoling;Zhang Jialan(Department of Ultrasound Medicine,Ankang Traditional Chinese Medicine Hospital,Ankang 725000,China)
出处
《国际医药卫生导报》
2025年第12期2051-2056,共6页
International Medicine and Health Guidance News
基金
陕西省中医药管理局科研项目(SZY-NLTL-2024-007)。
关键词
肝细胞肝癌
超声造影
病理学
分化程度
鉴别价值
Hepatocellular carcinoma
Contrast-enhanced ultrasound
Pathology
Degree of differentiation
Identification value
