原发性肝癌患者行DSA引导下肝动脉化疗栓塞后疗效评估中超声造影的价值

范晓华; 陈存国; 管建民; 陆文明; 邹涛

doi:10.16766/j.cnki.issn.1674-4152.002336

原发性肝癌患者行DSA引导下肝动脉化疗栓塞后疗效评估中超声造影的价值

doi: 10.16766/j.cnki.issn.1674-4152.002336

1.
湖州市第一人民医院超声科，浙江湖州 313000
2.
浙江省台州医院老年医学科，浙江台州 317000

基金项目:

浙江省基础公益研究计划项目 LGF19H180001

详细信息

通讯作者:
范晓华，E-mail：fanxiaohua1212@163.com

中图分类号: R735.7 R730.5
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- 文章访问数: 511
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- 被引次数: 0
出版历程
- 收稿日期: 2021-06-08
- 网络出版日期: 2022-03-04

Value of contrast-enhanced ultrasound in evaluating the efficacy of digital subtraction angiography-guided hepatic artery chemoembolisation in patients with hepatocellular carcinoma

1.
Department of Ultrasound, the First People's Hospital of Huzhou, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的探讨超声造影对原发性肝癌(HCC)患者行数字减影血管造影(DSA)引导下肝动脉化疗栓塞(TACE)后疗效评估中的作用。方法选取湖州市第一人民医院和浙江省台州医院2020年1月—2021年4月收治的HCC患者68例为研究对象，均行DSA引导下TACE治疗，治疗前后均采用超声造影进行疗效评估。结果 (1) 所有患者治疗后始增时间、达峰时间、峰值加速时间显著增加(t=11.701、10.383、10.119，均P＜0.05)，始增速度、增强速率显著降低(t=9.636、11.318，均P＜0.05)；(2)有效组治疗后始增时间、达峰时间、峰值加速时间显著大于治疗前(均P＜0.05)，始增速度、增强速率显著小于治疗前(均P＜0.05)；治疗后有效组始增时间、达峰时间、峰值加速时间显著大于无效组(t=7.867、12.407、16.127，均P＜0.05)，始增速度、增强速率显著小于无效组(t=12.134、23.613，均P＜0.05)；(3)始增时间、达峰时间、峰值加速时间、始增速度及增强速率AUC分别为0.657、0.718、0.642、0.669、0.714。结论超声造影中达峰时间和增强速率预测HCC患者行TACE治疗疗效价值高。
- 原发性肝癌 /
- 肝动脉化疗栓塞 /
- 超声造影 /
- 数字减影血管造影 /
- 疗效
Abstract: Objective To investigate the role of contrast-enhanced ultrasound in evaluating the efficacy of digital subtraction angiography (DSA) -guided hepatic artery chemoembolisation (TACE) in patients with hepatocellular carcinoma (HCC). Methods A total of 68 patients with HCC who were admitted to Huzhou First People's Hospital and Taizhou Hospital of Zhejiang Province from January 2020 to April 2021 were selected as study participants. All patients underwent DSA-guided TACE treatment, and contrast-enhanced ultrasound was used to evaluate the efficacy before and after treatment. Results (1) The initial increase time, peak time and peak acceleration time significantly increased after treatment (t=11.701, 10.383, 10.119, all P < 0.05), whereas the initial growth rate and the enhancement rate significantly reduced (t=9.636, 11.318, all P < 0.05). (2) The initial increase time, peak time and peak acceleration time were significantly longer after than before treatment (P < 0.05) in the effective group (t=7.867, 12.407, 16.127, all P < 0.05). The initial increase rate and enhancement rate were significantly lower after than before treatment (t=12.134, 23.613, all P < 0.05). (3) The initial increase time, peak time, peak acceleration time, initial increase speed and enhancement rate AUC were 0.657, 0.718, 0.642, 0.669 and 0.714, respectively. Conclusion The peak time and enhancement rate in contrast-enhanced ultrasound have high value in predicting the therapeutic effect of TACE in patients with HCC.
- Hepatocellular carcinoma /
- Hepatic artery chemoembolisation /
- Contrast-enhanced ultrasound /
- Digital subtraction angiography /
- Curative effect

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图 1 各指标对TACE治疗疗效预测ROC曲线图

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表 1 68例原发性肝癌患者治疗前后超声造影参数比较(x±s)

时间	始增时间(s)	达峰时间(s)	峰值加速时间(s)	始增速度(dB)	增强速率(dB/s)
治疗前	10.41±3.03	24.18±5.16	12.19±2.34	9.56±2.45	2.67±0.45
治疗后	15.49±5.05	37.43±11.82	23.63±10.34	6.31±2.94	1.62±0.68
t值	11.701	10.383	10.119	9.636	11.318
P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 2 不同疗效原发性肝癌患者超声造影参数比较(x±s)

组别	例数	始增时间(s)		达峰时间(s)		峰值加速时间(s)		始增速度(dB)		增强速率(dB/s)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
有效组	41	10.46±3.14	18.32±4.20^a	23.76±5.00	45.39±6.88^a	12.46±2.07	31.07±5.61^a	9.62±2.56	4.34±1.06^a	2.72±0.51	1.10±0.15^a
无效组	27	10.33±2.91	11.19±2.60	24.81±5.42	25.33±5.94	11.78±2.68	12.33±2.73	9.45±2.32	9.29±2.27	2.59±0.34	2.41±0.30
t值		0.172	7.867	0.826	12.407	1.186	16.127	0.284	12.134	1.199	23.613
P值		0.864	＜0.001	0.412	＜0.001	0.240	＜0.001	0.777	＜0.001	0.235	＜0.001
注：与同组治疗前比较，^aP＜0.05。

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表 3 不同指标对TACE治疗疗效的预测价值

项目	临界值	灵敏度(%)	特异度(%)	阳性预测值(%)	阴性预测值(%)
始增时间	13.26 s	63.04	67.71	74.35	55.25
达峰时间	31.27 s	71.75	77.44	82.55	64.87
峰值加速时间	16.26 s	58.69	70.98	75.00	53.65
始增速度	5.14 dB	65.34	67.76	75.04	56.78
增强速率	1.93 dB/s	73.93	70.98	80.96	65.74

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