探究超声造影（CEUS）以及血清甲胎蛋白（AFP）、癌胚抗原（CEA）、γ-谷氨酰转移酶（GGT）、碱性磷酸酶（ALP）对肝癌患者介入术后微血管侵犯（MVI）及复发的预测价值。

回顾性选取2021年5月至2023年5月济宁医学院附属医院收治的187例原发性肝细胞癌患者为研究对象，所有患者均在我院顺利完成经导管动脉化疗栓塞术治疗，并于术前1周完成CEUS和血清生化指标检测。通过术后病理学检查和随访确诊MVI和复发情况，分析CEUS影像学特征、血清AFP、CEA、GGT、ALP水平与术后MVI和复发的关系。

187例肝癌患者中有61例证实为MVI。单因素分析结果显示：MVI组患者中无或不完整包膜、门脉期信号快速消退、肿瘤内部坏死的发生率均明显高于非MVI组（P<0.05）；MVI组患者的血清AFP、CEA、GGT、ALP水平均明显高于非MVI组（P<0.05）。多因素Logistic回归分析显示：包膜无或不完整、门脉期信号快速消退、肿瘤内部坏死、血清AFP≥20 μg/L、CEA≥5 μg/L、GGT≥60 U/L、ALP≥120 U/L是影响介入术后出现MVI的独立危险因素（P<0.05）。经过术后1年的随访调查，187例肝癌患者中有45例出现复发。单因素分析显示：复发组患者中无或不完整包膜、边缘不光滑、门脉期信号快速消退、肿瘤内部坏死的发生率均明显高于非复发组，复发组患者的血清AFP、CEA、GGT、ALP水平均明显高于非复发组（P<0.05）。多因素Logistic回归分析显示：包膜无或不完整、边缘不光滑、门脉期信号快速消退、肿瘤内部坏死、血清AFP≥20 μg/L、CEA≥5 μg/L、GGT≥60 U/L、ALP≥120 U/L是影响术后复发的独立危险因素（P<0.05）。

CEUS检查中无或不完整包膜、门脉期信号快速消退、肿瘤内部坏死的原发性肝细胞癌患者在经导管动脉化疗栓塞术后出现MVI的风险更高；无或不完整包膜、边缘不光滑、门脉期信号快速消退、肿瘤内部坏死的肝癌患者出现术后复发的可能性更大。特定的CEUS影像学特征结合血清AFP、CEA、GGT、ALP等生化标志物对于原发性肝细胞癌患者介入术后MVI及复发均具有一定的早期预测价值。

To research the predictive value of contrast-enhanced ultrasound (CEUS), serum alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), γ-glutamyltransferase (GGT) and alkaline phosphatase (ALP) on microvascular invasion (MVI) and recurrence in patients with liver cancer after interventional therapy.

A total of 187 patients with primary liver cancer admitted to Affiliated Hospital of Jining Medical University from May 2021 to May 2023 were selected as the research objects. All patients successfully completed transcatheter arterial chemoembolization treatment in our hospital, and CEUS and serum biochemical indexes were detected one week before operation. The MVI and recurrence were diagnosed by postoperative pathological examination and postoperative follow-up, and the relationship between the imaging characteristics of CEUS, serum AFP, CEA, GGT and ALP levels and postoperative MVI and recurrence was analyzed.

Among 187 patients with liver cancer, 61 cases were confirmed as MVI. The results of univariate analysis showed that the incidence of no or incomplete capsule, rapid regression of portal vein signal and tumor necrosis in MVI group was significantly higher than that in non-MVI group. The levels of serum AFP, CEA, GGT and ALP in MVI group were significantly higher than those in non-MVI group (P<0.05). The results of multivariate Logistic regression analysis showed that no or incomplete capsule, rapid regression of portal vein signal, tumor necrosis, serum AFP≥20 μg/L, CEA≥5 μg/L, GGT≥60 U/L and ALP≥120 U/L were independent risk factors for MVI after interventional therapy (P<0.05). After a one-year follow-up survey, 45 of 187 patients with liver cancer recurred. The results of univariate analysis showed that the incidence of no or incomplete capsule, unsmooth edge, rapid fading of portal vein signal and internal necrosis of tumor in recurrent group were significantly higher than those in non-recurrent group, and the serum AFP, CEA, GGT and ALP levels in recurrent group were significantly higher than those in non-recurrent group (P<0.05). Multivariate Logistic regression analysis showed that no or incomplete capsule, unsmooth edge, rapid fading of portal vein signal, tumor necrosis, serum AFP≥20 μg/L, CEA≥5 μg/L, GGT≥60 U/L and ALP≥120 U/L were independent risk factors for postoperative recurrence (P<0.05).

Liver cancer patients with no or incomplete capsule in CEUS examination, rapid fading of portal vein signal and necrosis of tumor are at higher risk of MVI after operation. Liver cancer patients with no or incomplete capsule, unsmooth edge, rapid fading of portal vein signal and tumor necrosis are more likely to have postoperative recurrence. Specific CEUS imaging features combined with serum AFP, CEA, GGT, ALP and other biochemical markers have certain early predictive value for MVI and recurrence of liver cancer patients after interventional therapy.