目的:通过临床数据分析评估持续病毒学应答(SVR)后肝细胞癌(HCC)的风险,包括使用从双能计算机断层扫描(DECT)获得的细胞外体积分数(ECV)评估肝纤维化。
方法:92例患者(男52例,女40例;平均年龄,69.9年),在2020年1月至2022年3月之间,SVR进行了肝脏DECT(3分钟平衡相位图像)后感染丙型肝炎病毒。通过测量碘密度计算ECV;纤维标记,包括ECV,纤维化-4指数,天冬氨酸转氨酶与血小板比值指数,和血小板计数,进行统计学分析(p<0.05)。使用单因素和多因素logistic回归分析与HCC相关的危险因素。
结果:HCC患者的ECV(26.1±4.6%)(n,21)显着大于ECV(20.7±3.3%)的患者没有肝癌(n=71)(p<0.001)。ECV的截止值为24.3%。ECV的操作特征曲线下面积为0.857,高于血清纤维化标志物。年纪大了,用干扰素实现的SVR,甲胎蛋白水平(>5ng/mL),治疗前的晚期纤维化(>F3),根据单因素分析,ECV与HCC相关。多因素分析显示,ECV是与HCC独立相关的唯一因素(比值比0.619,95%置信区间0.482-0.795,p<0.001)。
结论:使用ECV评估的肝纤维化可以作为SVR后HCC患者的预测标志物。
OBJECTIVE: To assess hepatocellular carcinoma (HCC) risk after sustained virologic response (SVR) through clinical data analyses, including evaluation of liver fibrosis using the extracellular volume fraction (ECV) obtained from dual-energy computed tomography (DECT).
METHODS: Ninety-two patients (52 men and 40 women; mean age, 69.9 years) with hepatitis C virus infection after SVR underwent DECT of the liver (3-minute equilibrium-phase images) between January 2020 and March 2022. The ECV was calculated by measuring iodine density; fibrous markers, including ECV, fibrosis-4 index, aspartate aminotransferase to platelet ratio index, and platelet count, were statistically analyzed (p < 0.05). The risk factors associated with HCC were analyzed using univariate and multivariate logistic regression analyses.
RESULTS: The ECV (26.1 ± 4.6 %) in patients with HCC (n,21) was significantly larger than the ECV (20.7 ± 3.3 %) in patients without HCC (n = 71) (p < 0.001). The cutoff value for the ECV was 24.3 %. The area under the operating characteristic curve of the ECV was 0.857, which was higher than that of the serum fibrosis markers. Older age, SVR achieved with interferon, alpha-fetoprotein level (>5 ng/mL), advanced fibrosis before treatment (>F3), and ECV were associated with HCC according to the univariate analysis. Multivariate analyses showed that ECV was the only factor independently associated with HCC (odds ratio 0.619, 95 % confidence interval 0.482-0.795, p < 0.001).
CONCLUSIONS: Liver fibrosis estimated using ECV can be a predictive marker in patients with HCC after SVR.