【摘要】 目的:探讨肝细胞肝癌(HCC)治疗前后磁共振灌注成像(MRI-PWI)参数、可溶性Fas(sFas)、微小RNA-224(miR-224)含量变化及对短期生存状况的预测价值.方法:选取2018年1月～2019年10月我院89例HCC患者作为研究对象,均接受经皮肝动脉化疗栓塞术(TACE).统计HCC患者治疗前、治疗后4周及不同疗效、不同生存状况MRI-PWI参数[容积转运常数(Ktrans)、血管外细胞外间隙容积比(Vc)]、s Fas、miR-224水平,绘制受试者工作曲线(ROC)分析上述指标单一或联合预测HCC死亡价值,Kaplan-Meier(K-M)生存曲线、logistic回归分析上述指标与HCC死亡关系.结果:(1)89例HCC患者治疗后4周miR-224、sFas、Vc、Ktrans低于治疗前(P<0.05);(2)治疗后4周稳定患者miR-224、sFas、Vc、Ktrans低于进展患者(P<0.05);(3)治疗后随访12周,发现12例死亡,77例生存.治疗后4周生存患者miR-224、sFas、Vc、Ktrans低于死亡患者(P<0.05);(4)ROC显示,联合预测HCC患者死亡价值的AUC为0.881(95%CI:0.795～0.940),明显优于Ktrans、Vc、miR-224、s Fas单一预测;(5)KM曲线显示,sFas、miR-224、Vc、Ktrans高危组生存率低于低危组(P<0.05);(6)logistic回归模型显示,低分化程度、肿瘤直径≥5cm、肿瘤数目≥2个、Child-Pugh分级C级、微血管侵犯、淋巴结转移、sFas≤2.50μg/L、miR-224>2.06、Vc>0.82%、Ktrans>1.01min是影响HCC患者死亡危险因素(P<0.05).结论:HCC患者TACE治疗后MRI-PWI参数、s Fas、miR-224较治疗前明显改变,联合检测能较好预测HCC患者生存状况,为临床诊治提供科学依据.更多还原

【Abstract】 Objective:To investigate the changes of magnetic resonance perfusion imaging(MRI-PWI)parameters,soluble Fas(sFas)and microRNA-224(miR-22)levels before and after treatment of hepatocellular carcinoma(HCC)and their predictive value for short-term survival. Methods:From January 2018 to October 2019,89 patients with HCC in our hospital were selected as the research subjects,all of whom underwent percutaneous transhepatic arterial chemoembolization(TACE). Statistics of MRI-PWI parameters[volume transport constant(Ktrans),extravascular extracellular space volume ratio(Vc)],sFas,miR-224 levels of HCC patients before treatment,4 weeks after treatment and with different efficacy and different survival status. A receiver operating curve(ROC)was drawn to analyze the above indicators to predict the value of HCC death individually or jointly. Kaplan-Meier(K-M)survival curve and logistic regression analysis were used to analyze the relationship between the above indicators and HCC death. Results:(1)The miR-224,sFas,Vc,and Ktrans of 89 HCC patients were lower than those before treatment at 4 weeks after treatment(P<0.05);(2)MiR-224,sFas,Vc,Ktrans in stable patients at 4 weeks after treatment were lower than those in advanced patients(P<0.05);(3)Followed up for 12 weeks after treatment,12 cases were found dead and 77 cases survived. The miR-224,sFas,Vc,Ktrans of patients who survived at 4 weeks after treatment were lower than those who died(P<0.05);(4)ROC showed that the combined AUC for predicting the death value of HCC patients was 0.881(95%CI:0.795～0.940),which was significantly better than the single prediction of Ktrans,Vc,miR-224,and sFas;(5)The KM curve showed that the survival rate of sFas,miR-224,Vc,Ktrans high-risk group was lower than that of low-risk group(P<0.05);(6)Logistic regression model showed that the degree of poor differentiation,tumor diameter≥5 cm,tumor number≥2,Child-Pugh classification C grade,microvascular invasion,lymph node metastasis,sFas≤2.50 μg/L,miR-224>2.06,Vc>0.82%,Ktrans>1.01 min were the risk factors for death of HCC patients(P<0.05). Conclusion:The MRI-PWI parameters,sFas,and miR-224 of HCC patients changed significantly after TACE treatment. The combined detection can better predict the survival status of HCC patients and provide scientific basis for clinical diagnosis and treatment.更多还原