摘要
目的评估超声造影结合血清可溶性T细胞免疫球蛋白黏蛋白3(sTIM-3)、人软骨糖蛋白39(YKL-40)水平在胆囊病灶良恶性鉴别诊断中的价值。方法选取河北省邯郸市人民医院2021年5月到2023年11月收治的320例胆囊占位病变患者,根据术后病理结果分为良性组262例和恶性组58例。所有患者接受常规超声检查、超声造影及血清sTIM-3与YKL-40水平检测,比较两组患者的临床特征及检测指标。结果二维超声显示,恶性组病变形状不规则、病灶数量多发及浸润肝脏比例分别为74.14%、81.03%、43.10%,高于良性组的23.28%、46.56%、0.00%,差异有统计学意义(P<0.05),两组合并胆囊结石比较,差异无统计学意义(P>0.05)。超声造影显示,两组动脉期增强水平比较,差异无统计学意义(P>0.05)。分布特征方面,良性组表现出均匀分布的比例为73.66%,高于恶性组的56.90%(P<0.05)。静脉期增强水平方面,恶性组低增强的比例为82.76%,高于良性组的7.25%(P<0.05)。胆囊壁完整性方面,良性组的胆囊壁完整性比例为95.80%,高于恶性组的53.45%(P<0.05)。病灶基底方面,良性组的宽型病灶比例为46.95%,低于恶性组的96.55%(P<0.05)。恶性组血清sTIM-3与YKL-40水平分别为(3.20±1.18)ng/mL、(247.48±54.85)ng/mL高于良性组的(1.71±0.52)ng/mL、(168.80±34.19)ng/mL(P<0.01)。ROC曲线分析表明,超声造影对胆囊病灶良恶性的诊断灵敏度为82.8%,特异度为92.7%,AUC值为0.898。血清sTIM-3的灵敏度为81.0%,特异度为88.2%,AUC值为0.883。YKL-40的灵敏度为82.8%,特异度为84.0%,AUC值为0.891。当超声造影与sTIM-3和YKL-40联合使用时,灵敏度提高至91.4%,特异度达到98.1%,AUC值为0.966。结论超声造影联合血清sTIM-3和YKL-40水平检测能够显著提高胆囊病灶良恶性鉴别的准确性,为临床提供更为可靠的参考依据。
Objective To evaluate the diagnostic value of contrast-enhanced ultrasound combined with serum soluble T cell immunoglobulin mucin-3(sTIM-3)and YKL-40 levels in differentiating malignant and benign gallbladder lesions.Methods A total of 320 patients with gallbladder occupying lesions admitted to Handan People's Hospital from May 2021 to November 2023 were selected.According to postoperative pathological results,patients were divided into a benign group(262 cases)and a malignant group(58 cases).All patients underwent routine and contrast-enhanced ultrasound examinations,and serum sTIM-3 and YKL-40 level testing.Clinical characteristics and detection indicators were compared between the two groups.Results Two-dimensional ultrasound showed that the proportions of irregular lesion shapes,multiple lesion numbers,and liver infiltration in the malignant group were 74.14%,81.03%,and 43.10%,respectively,which were higher than those in the benign group(23.28%,46.56%,and 0.00%,respectively)(P<0.05).There was no significant difference in the comparison of combined gallbladder stones between the two groups(P>0.05).Contrast-enhanced ultrasound showed that there was no significant difference in the enhancement levels during the arterial phase between the two groups(P>0.05).In terms of distribution characteristics,the proportion of uniform distribution in the benign group was 73.66%,which was higher than that in the malignant group(56.90%)(P<0.05).In terms of the enhancement level during the venous phase,the proportion of low-level enhancement in the malignant group was 82.76%,which was higher than that in the benign group(7.25%)(P<0.05).In terms of the integrity of the gallbladder wall,the proportion of the integrity of the gallbladder wall in the benign group was 95.80%,which was higher than that in the malignant group(53.45%)(P<0.05).In terms of the lesion base,the proportion of wide-type lesions in the benign group was 46.95%,which was lower than that in the malignant group(96.55%)(P<0.05).The serum sTIM-3 and YKL-40 levels in the malignant group were(3.20±1.18)ng/mL and(247.48±54.85)ng/mL,respectively,which were higher than those in the benign group[(1.71±0.52)ng/mL and(168.80±34.19)ng/mL,respectively](P<0.01).ROC curve analysis showed that the sensitivity of contrast-enhanced ultrasound for diagnosing malignant and benign gallbladder lesions was 82.8%,with a specificity of 92.7%and an AUC of 0.898.The sensitivity for serum sTIM-3 was 81.0%,specificity 88.2%,and AUC 0.883.For YKL-40,the sensitivity was 82.8%,specificity 84.0%,and AUC 0.891.When combining contrast-enhanced ultrasound with sTIM-3 and YKL-40,sensitivity increased to 91.4%,specificity reached 98.1%,and the AUC value was 0.966.Conclusion The detection of contrast-enhanced ultrasound combined with serum sTIM-3 and YKL-40 levels can significantly improve the accuracy of differentiating between benign and malignant gallbladder lesions,providing a reliable reference for clinical practice.
作者
胡丽军
连倩倩
HU Li-jun;LIAN Qian-qian(Ultrasound Department of Handan People's Hospital,Hebei 056001,China;Functional Department of Cheng'an County Hospital,Handan City,Hebei 056700,China)
出处
《肝脏》
2025年第5期722-726,共5页
Chinese Hepatology
基金
河北省自然科学基金项目(H2021206093)。
关键词
超声造影
胆囊病灶
可溶性T细胞免疫球蛋白黏蛋白3
人软骨糖蛋白39
良恶性鉴别
Contrast-enhanced ultrasound
Gallbladder lesions
Soluble T cell immunoglobulin mucin-3
YKL-40
Differentiation of benign and malignant lesions
