超声造影联合血γ-GT水平在原发性肝癌患者TACE术后疗效评估中的价值

摘要/Abstract

摘要： 目的分析超声造影(CEUS)联合血γ-谷氨酰转肽酶(γ-GT)水平在原发性肝癌(PHC)患者经导管动脉栓塞术(TACE)术后疗效评估中的价值。方法 80例接受TACE介入治疗的PHC患者,患者治疗前后均进行CEUS检查,于术前及术后7 d、28 d、2个月检测血γ-GT水平。结果 80例PHC患者接受TACE介入治疗前均进行CEUS检查,共发现109个病灶,表现为动脉期均匀性或不均匀性高增强;经TACE介入治疗后2个月,CEUS检查显示35例患者37个病灶完全灭活,45例患者72个病灶为肿瘤残留;术后7 d,PHC患者血γ-GT水平较术前明显上升(P<0.05),术后28 d,γ-GT水平较术前、术后7 d明显下降(P<0.05),术后2个月,γ-GT水平较术前、术后7 d、28 d明显下降(P<0.05);联合检测诊断PHC的灵敏度、阳性预测值、阴性预测值以及诊断符合率高于γ-GT检测(P<0.05),与CEUS检查差异比较,不具有统计学意义(P>0.05)。结论 CEUS检查可对PHC患者TACE术后残留病灶进行准确诊断,联合血γ-GT水平检测可提高对PHC诊断的敏感度,降低误诊、漏诊率,在PHC患者TACE术后疗效评估中具有一定的应用价值。

关键词: 超声造影, γ-GT, 原发性肝癌, TACE术, 疗效评估

Abstract: Objective To analyze the value of using contrast-enhanced ultrasound (CEUS) in combination with blood γ-glutamyltransferase (γ-GT) level to evaluate the efficacy of transcatheter arterial chemoembolization (TACE) therapy for patients with primary hepatocellular carcinoma (PHC). Methods Eighty PHC patients who underwent TACE interventional therapy were selected. CEUS was performed in all patients before and after TACE. Blood γ-GT level was detected before TACE and at 7d, 28d and 2 months after the surgery. The value of combine CEUS examination with blood γ-GT level to evaluate the efficacy of TACE on PHC patients was analyzed. Results CEUS examination was performed in 80 patients with PHC before TACE. A total of 109 lesions were found, showing mild and diffuse enhancement. At 2 months after TACE, CEUS re-examination showed that 37 lesions in 35 patients were completely destroyed, and 72 lesions in 45 patients were residual tumors. At 7d after surgery, the blood γ-GT level in PHC patients was significantly increased compared with that of before surgery (P<0.05), and the γ-GT level at 28d after surgery was significantly decreased compared with those of before surgery, and 7d after surgery (P<0.05). The γ-GT level at 2 months after surgery was significantly lower than that of before surgery and those of 7d and 28d after surgery (P<0.05). The sensitivity, positive predictive value, negative predictive value and diagnostic coincidence rate of the combined detection for the diagnosis of PHC were higher than those of γ-GT detection (P<0.05), and there were no statistical differences when compared with those of CEUS examination (P>0.05). Conclusion CEUS examination can accurately diagnose residual lesions in patients with PHC after TACE. The combination of CEUS with blood γ-GT level increase the sensitivity for diagnosing PHC, and reduce the misdiagnosis and missed diagnosis rates. It has certain application value for evaluating the efficacy of TACE therapy for PHC patients.

Key words: Contrast-enhanced ultrasound, γ-GT, Primary hepatocellular carcinoma, Transcatheter arterial chemoembolization, Efficacy evaluation

李丛辉, 罗红缨, 王建钧, 邝学军, 鲍永慧. 超声造影联合血γ-GT水平在原发性肝癌患者TACE术后疗效评估中的价值[J]. 肝脏, 2021, 26(3): 266-269.

LI Cong-hui, LUO Hong-ying, WANG Jian-jun, KUANG Xue-jun, BAO Yong-hui. The value of using contrast-enhanced ultrasound in combination with blood γ-GT level to evaluate the efficacy of transcatheter arterial chemoembolization therapy for patients with primary hepatic carcinoma[J]. Chinese Hepatolgy, 2021, 26(3): 266-269.

参考文献

[1] Alima, Li W, Wang J, et al. Impact of pathological features of primary hepatocellular carcinoma on the outcomes of intrahepatic recurrence management: single center experience from Southern Taiwan. HPB (Oxford), 2016, 18:851-860.
[2] 钟国辉,田猛,李开锋,等.普美显增强磁共振与甲胎蛋白结合探讨肝癌相关性的研究现状.中国实验诊断学,2019,23:1098-1100.
[3] 周宇杰,徐细明,梁慧玲,等.肝动脉化疗栓塞术对原发性肝癌患者肝肾功能及血常规的影响.临床与病理杂志,2017,37:2407-2415.
[4] Ai N, Liu W, Li Z, et al. High expression of GP73 in primary hepatocellular carcinoma and its function in the assessment of transcatheter arterial chemoembolization. Oncol Lett, 2017,14:3953-3958.
[5] 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版).中华肝脏病杂志,2017,25:886-895.
[6] 王永华,吴庭苗.经导管肝动脉化疗栓塞术联合¹²⁵I放射性粒子治疗肝癌的临床应用现状及进展.中华核医学与分子影像杂志,2019,39:112-115.
[7] Cai Y, Chang Q, Xiao E, et al. Transcatheter arterial chemoembolization (TACE) combined with γ-knife compared to TACE or γ-knife alone for hepatocellular carcinoma. Medicine (Baltimore), 2018, 97:10890-10897.
[8] 廖云忠,关秀丽,彭小萍,等.TACE术中应用吉西他滨对原发性肝癌疗效及血清甲胎蛋白的影响.解放军医药杂志,2019,31:39-42.
[9] 王一焯,苟庆,许荣德,等.肝动脉化疗栓塞与单纯栓塞治疗原发性肝癌近期疗效的回顾性比较.临床放射学杂志,2018,37:855-859.
[10] Röttgen R, Kobi S, Grieser C, et al. Assessing the malignancy of hepataocellular carcinoma in cirrhosis using the hepatocellular contrast agent Gd-EOB-DTPA and correlation with the cytometric DNA index. Molecular Imaging, 2013,3:1-7.
[11] 唐继芳.螺旋CT与磁共振成像对乙型肝炎肝硬化背景小肝癌的诊断对比研究.山西医药杂志,2018,47:19-22.
[12] Moudgil S, Kalra N, Prabhakar N, et al. Comparison of Contrast Enhanced Ultrasound With Contrast Enhanced Computed Tomography for the Diagnosis of Hepatocellular Carcinoma. J Clin Exp Hepatol, 2017,7:222-229.
[13] Li R, Tang CL, Yang D, et al. Primary hepatic neuroendocrine tumors: clinical characteristics and imaging features on contrast-enhanced ultrasound and computed tomography. Abdom Radiol (NY), 2016, 41:1767-1775.
[14] 贵传玲.超声造影技术对原发性肝癌介入治疗效果的评估价值.山东医药,2016,56:86-88.
[15] Sun P, Li Y, Chang L, et al. Prognostic and clinicopathological significance of Gamma-Glutamyltransferase in patients with hepatocellular carcinoma: A PRISMA-compliant meta-analysis. Medicine (Baltimore), 2019, 98:15603-15610.
[16] 周辉,李俊红,李蔼峰,等.肝胆显像结合血清γ－GT/TBA比值对先天性肝外胆道闭锁的诊断价值.中华核医学与分子影像杂志,2018,38:736-740.
[17] Mok Y, Son D, Yun Y, et al. γ-Glutamyltransferase and cancer risk: The Korean cancer prevention study. International Journal of Cancer, 2016, 138:311-319.
[18] Choi Y, Lee D, Han K, et al. Elevated serum gamma-glutamyltransferase is associated with an increased risk of oesophageal carcinoma in a cohort of 8,388,256 Korean subjects. PLoS One, 2017, 12:177053-177064.
[19] Ma H, Zhang L, Tang B, et al. γ-Glutamyltranspeptidase is a prognostic marker of survival and recurrence in radiofrequency-ablation treatment of hepatocellular carcinoma. Ann Surg Oncol, 2014, 21:3084-3089.