超声造影联合血清CA19-9鉴别诊断胆管细胞癌与肝细胞癌应用研究

目的 探讨肝内胆管细胞癌(ICC)与肝细胞癌(HCC)患者超声造影(CEUS)和血清糖类抗原19-9(CA19-9)水平变化特征。方法 经组织病理学检查诊断的ICC患者48例和HCC患者78例,进行CEUS检查,常规检测血清CA19-9。建立鉴别诊断ICC与HCC的多指标二元Logistic回归方程,探索其诊断ICC的价值。结果 45.8%ICC患者以肿瘤周围环状增强为主,显著高于HCC患者的2.6%(P<0.05);58.3%ICC患者造影剂显著廓清,而94.9% HCC呈弱或无廓清(P <0.05);ICC组廓清时间为(54.6±10.2)s,显著早于HCC组【(76.1±25.1)s,P <0.05】;72.9%ICC患者血清CA19-9升高,显著高于HCC组的19.2%(P<0.05);建立多指标联合的二元Logistic诊断模型方程为:Logit(P)=-4.030+2.640×增强模式+2.486×廓清时间+2.579×廓清程度+2.731×血清CA19-9 (U/ml),该模型识别ICC的AUC为0.943,其敏感度和特异度分别为79.2%和93.6%。结论 熟悉ICC与HCC的超声造影表现特征,结合血清CA19-9水平,可以帮助鉴别这两种肿瘤。

Contrast-enhanced ultrasonography and serum CA19-9 levels in differential diagnosis of patients with intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma

Objective The aim of this study was to evaluate the value of contrast-enhanced ultrasound (CEUS) and serum carbohydrate antigen (Ca19-9) levels in differential diagnosis of patients with intrahepatic cholangiocellular carcinoma (ICC) and hepatocellular carcinoma (HCC). Methods 48 patients with histopathological confirmed ICC and 78 patients with histopathological confirmed HCC were enrolled in this study, and all underwent CEUS and serum CA19-9 levels were detected. A binary Logistic regression model was established for the differential diagnosis of ICC and HCC. Results 45.8% ICC patients had peripheral rim enhancement of tumors at CEUS, significantly higher than 2.6% in HCC patients (P <0.05); the marked washout was found in 58.3% of ICC patients,However, 94.9% HCC patients were weak or not washout (P <0.05); the washout time in ICC group was(54.6±10.2)s, significantly earlier than (76.1±25.1)s in HCC group (P <0.05); 72.9% ICC patients had increased serum CA19-9 levels, significantly higher than 19.2% in HCC group (P<0.05); a binary Logistic diagnostic model equation was established: e.g. Logit(P)=-4.030+2.640×enhancement mode +2.486×washout time +2.579×washout degree +2.731×CA19-9 (u/ml), and the AUC was 0.943, with the sensitivity and specificity of 79.2% and 93.6% (P<0.05) in diagnosing ICC by this equation. Conclusion Compared with the diagnostic effect of a single indicator, logistic regression analysis based multi-indicator combined differential diagnosis of ICC and HCC has higher diagnostic value.