动态增强MRI联合血清SPINK1水平诊断原发性肝癌价值研究*

doi:10.3969/j.issn.1672-5069.2024.03.031

摘要/Abstract

摘要： 目的探讨动态增强磁共振(MRI)联合血清丝氨酸蛋白酶抑制剂因子Kazal 1型(SPTINK1)水平诊断原发性肝癌(PLC)的价值。方法 2020年4月～2023年4月我院收治的乙型肝炎肝硬化患者204例,均接受动态增强MRI扫描检查,对肝内占位性病变者行细针穿刺病理学检查。采用ELISA法检测血清SPTINK1和甲胎蛋白水平。应用二元多因素Logistic回归分析诊断HCC的血清指标,应用受试者工作特征曲线(ROC)分析血清指标的诊断效能。结果在204例乙型肝炎肝硬化患者中,发现肝内占位性病变并经穿刺病理学检查诊断肝细胞癌(HCC)30例(14.7%);HCC组血清SPTINK1和AFP水平分别为(23.9±5.2)ng/mL和(426.5±67.0)ng/mL,显著高于肝硬化组【分别为(7.4±2.1)ng/mL和(14.4±4.3)ng/mL,P＜0.05】; 血清SPTINK1(OR:3.69,95%CI:1.08～12.49)和甲胎蛋白(AFP,OR:3.54,95%CI:1.04～11.98)均与HCC高度相关;以血清AFP水平大于等于360.1 ng/mL为截断点,其诊断HCC的AUC为0.80(95%CI:0.72～0.89),灵敏度和特异度分别为71%和73%,以血清SPTINK1水平等于或大于15.6 ng/mL为截断点,其诊断HCC的AUC为0.82(95%CI:0.74～0.91),灵敏度和特异度分别为82%和79%。结论在肝硬化患者,经影像学检查发现肝内占位性病变时,血清SPINK1和AFP水平升高可以帮助初步判断病变性质,应尽早进行穿刺病理学检查。

关键词: 肝细胞癌, 肝硬化, 增强磁共振成像, 丝氨酸蛋白酶抑制剂因子Kazal 1型, 甲胎蛋白, 诊断

Abstract: Objective The purpose of this study was to investigate the diagnostic performance of serum serine protease inhibitor Kazal type 1 (SPINK1) levels for hepatocellular carcinoma (HCC) in patients with hepatitis B-induced liver cirrhosis (LC). Methods A total of 204 consecutive patients with hepatitis B-induced LC were encountered in our hospital between April 2020 and April 2023, andall underwent dynamic contrast-enhanced magnetic resonance imaging (MRI). The patients who had intrahepatic space-occupying lesions received fine needle aspiration biopsies (FNAB) for histo-pathological examination. Serum SPTINK1 and alpha-fetoprotein (AFP) levels were detected by ELISA. The multivariate Logistic regression analysis and receiver-operating characteristic curve (ROC) were applied to predict the diagnostic efficacy. Results Out the 204 patients with hepatitis B-induced LC, the intrahepatic space-occupying lesions were found in 30 cases(14.7%)by MRI, and the histo-pathological examination showed all with HCC; serum SPTINK1 and AFP levels in patients with HCC were (23.9±5.2)ng/mL and (426.5±67.0)ng/mL, both significantly higher than [(7.4±2.1)ng/mL and (14.4±4.3)ng/mL, respectively, P＜0.05] in those with LC; both serum SPTINK1(OR:3.69, 95%CI:1.08-12.49) and AFP (OR:3.54, 95%CI:1.04-11.98) were positively correlated to HCC existence; the AUC was 0.80(95%CI:0.72-0.89), with the sensitivity (Se) of 71% and the specificity (Sp) of 73%, when serum AFP level equal to or greater than 360.1 ng/mL was set as the cut-off-value, and the AUC was 0.82(95%CI:0.74-0.91), with the Se of 82% and the Sp of 79%, when serum SPTINK1 level equal to or greater than 15.6 ng/mL was set as the cut-off-value in diagnosing HCC. Conclusion The elevated serum SPINK1 and AFP levels might hint the malignant tumor in LC patients with MRI-proven space-occupying lesions, and the FNAB could determine the diagnosis.

Key words: Hepatoma, Liver cirrhosis, Enhanced magnetic resonance, Protease inhibitor Kazal type 1, Alpha-fetoprotein, Diagnosis

王倩文, 胡琳琳, 徐运军. 动态增强MRI联合血清SPINK1水平诊断原发性肝癌价值研究^*[J]. 实用肝脏病杂志, 2024, 27(3): 442-445.

Wang Qianwen, Hu Linlin, Xu Yunjun. Diagnostic performance of serum SPINK1 levels for hepatocellular carcinoma in patients with hepatitis B-induced liver cirrhosis[J]. Journal of Practical Hepatology, 2024, 27(3): 442-445.

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动态增强MRI联合血清SPINK1水平诊断原发性肝癌价值研究^*

Diagnostic performance of serum SPINK1 levels for hepatocellular carcinoma in patients with hepatitis B-induced liver cirrhosis

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