目的:探讨能谱CT联合血清甲胎蛋白(AFP)、血管内皮生长因子(VEGF)在肝细胞癌(HCC)患者肝动脉化疗栓塞(TACE)术后随访中的应用价值。方法:选取2016年1月至2019年8月在绵阳市中心医院行TACE治疗的73例HCC患者为研究对象,复查DSA、能谱CT及进行血清AFP、VEGF水平检测,根据研究对象是否存在残留或复发病灶将其分为复发组(22例)与未复发组(51例),绘制受试者工作特征(ROC)曲线评估血清AFP、VEGF对HCC患者TACE术后肿瘤残留、复发的诊断价值;以DSA造影检查结果为金标准,以四格表分析能谱CT及其联合AFP、VEGF对HCC患者TACE术后肿瘤残留、复发的诊断价值。结果:能谱CT诊断HCC患者TACE术后肿瘤残留、复发的病灶数量的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为90.59%、86.96%、89.31%、92.77%、83.33%。能谱CT对判断TACE术后肿瘤残留、复发的HCC患者的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为81.82%、90.20%、87.67%、78.26%、92.00%;血清AFP诊断HCC患者TACE术后肿瘤残留、复发的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为81.82%、82.35%、82.19%、66.67%、91.30%;血清VEGF诊断HCC患者TACE术后肿瘤残留、复发的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为77.27%、74.51%、75.34%、56.67%、88.37%;能谱CT联合AFP、VEGF对判断HCC患者TACE术后肿瘤残留、复发的灵敏度、特异度、准确度、阳性预测值、阴性预测值分别为95.45%、72.55%、79.45%、60.00%、98.37%,较单独诊断灵敏度、阴性预测值提高。结论:能谱CT联合AFP、VEGF对HCC患者TACE术后肿瘤残留、复发有一定诊断价值,可能为HCC患者TACE术后病情监测提供临床参考。

Objective: To investigate the value of spectral CT combined with serum α-fetoprotein (AFP) and vascular endothelial growth factor (VEGF) in the follow-up of patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE).Methods: A total of 73 patients with HCC treated by TACE in Mianyang Central Hospital from January 2016 to August 2019 were selected as the research objects. DSA and spectral CT were reviewed, serum AFP and VEGF levels were detected, according to the presence or absence of residual or recurrent lesions, the subjects were divided into recurrence group (22 cases) and non recurrence group (51 cases), receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of serum AFP and VEGF in HCC patients with residual and recurrent tumor after TACE; with DSA as the gold standard, the diagnostic value of spectral CT combined with AFP and VEGF in HCC patients after TACE was analyzed.Results: The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of spectral CT in detecting residual and recurrent lesions after TACE in patients with HCC were 90.59%, 86.96%, 89.31%, 92.77% and 83.33% respectively. the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of spectral CT in the diagnosis of residual and recurrent tumor after TACE in patients with HCC were 81.82%, 90.20%, 87.67%, 78.26% and 92.00%, respectively; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of serum AFP in the diagnosis of residual and recurrent tumor after TACE in patients with HCC were 81.82%, 82.35%, 82.19%, 66.67% and 91.30%, respectively; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of serum VEGF in the diagnosis of residual and recurrent tumor after TACE in patients with HCC were 77.27%, 74.51%, 75.34%, 56.67% and 88.37%, respectively; the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of spectral CT combined with AFP and VEGF in residual and recurrent tumor after TACE in patients with HCC were 95.45%, 72.55%, 79.45%, 60.00% and 98.37%, respectively, and the sensitivity and negative predictive value were higher than those of single diagnosis.Conclusion: Spectral CT combined with AFP and VEGF have a certain diagnostic value for residual and recurrent tumor after TACE in HCC patients, it may provide clinical reference for monitoring the condition of HCC patients after TACE.