肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立*

doi:10.3969/j.issn.1672-5069.2022.06.020

摘要/Abstract

摘要： 目的探讨存在LR-3类肝内结节的肝硬化患者恶性转变的危险因素,并在此基础上建立恶性转变预测模型。方法 2014年3月～2016年3月我院诊治的124例存在肝内LR-3类结节的肝硬化患者,规律随访进行磁共振成像(MRI)检查,对可疑病灶进行穿刺活检。应用多因素Logistic回归分析影响癌变的危险因素,并建立预测模型。结果经随访60～78个月(平均74个月),120例患者完成随访,发现癌变24例(20.0%),另96例无癌变;癌变组有饮酒、吸烟、合并糖尿病、乙型肝炎病毒感染和酒精性肝炎者分别为91.7%、87.5%、75.0%、100.0%和41.7%,显著高于未癌变组(分别为45.8%、52.1%、41.7%、58.3%和20.8%,P<0.05);Cox风险回归分析显示,饮酒(HR=2.264,95%CI=1.597～3.210,P<0.001)、糖尿病(HR=1.294,95%CI=1.107～1.513,P=0.001)、乙型肝炎(HR=1.795,95%CI=1.329～2.561,P<0.001)和酒精性肝炎(HR=0.658,95%CI=0.552～0.784,P<0.001)是存在LR-3类病变结节的肝硬化患者癌变的独立危险因素;根据Cox多因素分析结果建立癌变预测模型,即Y=0.817X₁+0.258X₂+0.585X₃-0.419X₄(X₁=饮酒,X₂=糖尿病,X₃=乙型肝炎,X₄=酒精性肝炎)。经ROC分析显示,该模型判断LR-3类病变结节患者癌变风险的AUC为0.812(SE=0.064,95%CI=0.687～0.936,P<0.001),其敏感度为0.833,特异度为0.673。结论了解危险因素可能对判断肝硬化患者肝内结节的性质有帮助,加强随访,必要时穿刺才是明确诊断的正确方法。

关键词: 肝硬化, 肝内结节, 肝脏影像报告和数据管理系统, 肝细胞癌, 危险因素, 预测模型

Abstract: Objective The purpose of this study was to explore the qualitative evaluation of intrahepatic nodules in patients with liver cirrhosis. Methods A retrospective analysis was performed on 124 cirrhotics with liver imaging reporting and data system (LI-RADS) 3 intrahepatic nodules. All, but fourpatients were followed-up for 60-78 (mean 74) months, and the MRI was conducted regularly. The fine needle aspiration liver biopsies werecarried out when necessary. The multivariate Logistic analysis was performed to reveal the risk factors. Results At the end of follow-up, 4 patients lost, and the cancerous foci were found in 24 cases (20.0%); the percentages of alcohol-taking, cigarettes smoking, concomitant diabetes, hepatitis B viral infections and alcoholic hepatitis in patients with intrahepatic cancerous lesions were 91.7%, 87.5%, 75.0%, 100.0% and 41.7%, allsignificantly higher than 45.8%, 52.1%, 41.7%, 58.3% and 20.8% (P<0.05) in patients without cancerous lesions; the Cox analysis showed that the alcohol-taking(HR=2.264, 95%CI=1.597-3.210, P<0.001), diabetes (HR=1.294, 95%CI=1.107-1.513, P=0.001), hepatitis B (HR=1.795, 95%CI=1.329- 2.561, P<0.001) and alcoholic hepatitis (HR=0.658, 95%CI=0.552-0.784, P<0.001) were the independent risk factors for patients with LR-3 intrahepatic foci; the formula was established based on the Cox analysis results, e.g.,Y=0.817X₁+0.258X₂+0.585X₃-0.419X₄(X₁=alcohol-taking, X₂=diabetes, X₃=hepatitis B, X₄=alcoholic hepatitis), and the ROC analysis demonstrated that the AUC was 0.812(SE=0.064, 95%CI=0.687-0.936, P<0.001), with the sensitivity of 0.833 and the specificityof 0.673, for liver cirrhotics with intrahepatic LR-3 nodules. Conclusion It might be important to follow-up liver cirrhosis patients with intrahepatic LR-3 nodules, especially in those with risk factors for malignant transformation, which could find cancerous lesions as soon as possible.

Key words: Liver cirrhosis, Magnetic resonance imaging, Liver imaging reporting and data system, Intrahepatic nodules, Hepatocellular carcinoma, Risk factors, Prediction

沈亦亮, 沈冬元, 陈永莹, 江凯, 朱逸明, 葛尚. 肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立^*[J]. 实用肝脏病杂志, 2022, 25(6): 836-839.

Shen Yiliang, Shen Dongyuan, Chen Yongying, et al.. Qualitative evaluation of intrahepatic nodules in patients with liver cirrhosis[J]. Journal of Practical Hepatology, 2022, 25(6): 836-839.

参考文献

[1] Vogel A , Martinelli E . Updated treatment recommendations for hepatocellular carcinoma (HCC) from clinical practice guidelines. Ann Oncol, 2021,32(4):801-805.
[2] Nderitu P , Bosco C , Garmo H , et al. The association between individual metabolic syndrome components, primary liver cancer and cirrhosis: a study in the Swedish amoris cohort. Int Jo Cancer, 2017,141(6):1148-1160.
[3] Poynard T , Peta V , Deckmyn O , et al. Lcr1 and lcr2, two multi-analyte blood tests to assess liver cancer risk in patients without or with cirrhosis. Aliment Pharmacol Ther, 2019,43(3):308-320.
[4] Kono Y , Lyshchik A , Cosgrove D , et al. Contrast enhanced ultrasound (ceus) liver imaging reporting and data system (li-rads): the official version by the American college of radiology (ACR). Ultraschall Med, 2017, 38(1):85-86.
[5] Vernuccio F , Cannella R , Meyer M , et al. LI-RADS: Diagnostic performance of hepatobiliary phase hypointensity and major imaging features of lr-3 and lr-4 lesions measuring 10–19 mm with arterial phase hyperenhancement. AJR, 2019, 213(2):57-65.
[6] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019,22(6):770-792.
[7] 中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会, 等.原发性肝癌规范化病理诊断指南(2015年版).中华肝脏病杂志,2015,23(5):321-327.
[8] 邢飞, 陆健, 张涛,等. 肝硬化背景下MRI肝脏影像报告和数据系统LR-2,LR-3,LR-4类结节的变化与预后. 中华放射学杂志, 2018, 52(4):272-276.
[9] Lee S M , Lee J M, Ahn S J , et al. LI-RADS version 2017 versus version 2018: diagnosis of hepatocellular carcinoma on gadoxetate disodium–enhanced MRI. Radiology, 2019, 292(3):655-663.
[10] 张学秀,王立峰,金磊, 等.原发性胆汁性肝硬化患者发生肝癌危险因素的研究进展.中华肝脏病杂志,2015,23(2):147-149.
[11] Persson EC , Schwartz LM , Park Y , et al. Alcohol consumption, folate intake, hepatocellular carcinoma, and liver disease mortality. Cancer Epidemiol Biomarkers Prev, 2013, 22(3):415-421.
[12] Moriya A , Iwasaki Y , Ohguchi S , et al. Roles of alcohol consumption in fatty liver: a longitudinal study. J Hepatol, 2015, 62(4):921-927.
[13] 张利利,李玉芳,张驰, 等.乙型肝炎肝硬化合并2型糖尿病发生原发性肝癌的风险研究.中华肝脏病杂志,2019,27(10):788-792.
[14] Wang Y, He HY, Chang JT, et al. Mueller matrix microscope: a quantitative tool to facilitate detections and fibrosis scorings of liver cirrhosis and cancer tissues. J Biomed Opt, 2016, 21(7):711-716.
[15] Chen XQ , Fan W , Liu YM , et al. The contribution of serum hepatitis b virus load in the carcinogenesis and prognosis of hepatocellular carcinoma: evidence from two meta-analyses. Oncotarget, 2016, 7(31):49299-49309.
[16] Wu JL , Xiang ZY , Bai L , et al. Diagnostic value of serum pivka-ii levels for bclc early hepatocellular carcinoma and correlation with HBV DNA. Cancer Biomark, 2018, 23(2):235-242.
[17] Tanaka Y , Esumi M , Shikata T . Frequent integration of hepatitis B virus DNA in noncancerous liver tissue from hepatocellular carcinoma patients. J Med Virol, 2010, 26(1):7-14.
[18] Ren Y D , Ye Z S , Yang L Z , et al. Fecal microbiota transplantation induces HBeAg clearance in patients with positive HBeAg after long-term antiviral therapy. Hepatology, 2016, 65(5):1765-1768.
[19] Bassendine M F , Seta L D , Salmeron J , et al. Incidence of hepatitis B virus infection in alcoholic liver disease, HBsAg negative chronic active liver disease and primary liver cell cancer in Britain. Liver, 2010, 3(2):65-70.
[20] Bai H , Liu H , Chen X , et al. Influence of age and HBeAg status on the correlation between HBV DNA and hepatic inflammation and fibrosis in chronic hepatitis B patients. Dig Dis Sci, 2013, 58(5):1355-1362.

肝硬化患者肝内LR-3类结节恶变风险评估及预测模型的建立^*

Qualitative evaluation of intrahepatic nodules in patients with liver cirrhosis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	韩涛, 刘艳迪, 胡家轩. 肝病合并肾损伤临床诊治新进展[J]. 实用肝脏病杂志, 2022, 25(6): 761-763.
[2]	蒋莹莹, 丁惠国. 肝硬化并发急性肾损伤临床管理现状与挑战[J]. 实用肝脏病杂志, 2022, 25(6): 764-767.
[3]	韩芳, 李佳峥, 南月敏. 肝硬化并发急性肾损伤诊治进展[J]. 实用肝脏病杂志, 2022, 25(6): 768-771.
[4]	贺潇瑾, 李丹, 周青, 欧阳静, 田玉球, 谭英征. L02细胞乙型肝炎病毒X蛋白和SOCS-1基因水平研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 772-775.
[5]	徐超, 李兰, 罗东, 赵海云, 彭飞. TIPS术治疗的肝硬化并发EVB患者医院内死亡风险预测模型的构建与应用^*[J]. 实用肝脏病杂志, 2022, 25(6): 840-843.
[6]	林秀慧, 李南, 张娇珍, 符庆忠, 林秀华. 慢性HBV感染者外周血PNPLA3/PRKAA1基因多态性与肝硬化发生关系研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 844-847.
[7]	朱海艳, 范晓棠. 肝硬化并发门静脉血栓形成患者列线图预测模型分析及外部验证[J]. 实用肝脏病杂志, 2022, 25(6): 848-852.
[8]	孙静, 张伟伟, 马智勇, 代树本, 邓彦东. 经颈静脉肝内门体分流术联合胃冠状静脉栓塞术治疗乙型肝炎肝硬化并发食管胃静脉曲张患者效果分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 853-856.
[9]	李响, 张铁英, 张旭辉, 孟繁坤. 基于超声参数的半定量评分评估乙型肝炎肝硬化食管静脉曲张价值探讨^*[J]. 实用肝脏病杂志, 2022, 25(6): 857-860.
[10]	张耀辉, 郑章增, 高星, 张亚利. 超声造影时间-强度曲线诊断肝硬化患者肝内小结节病灶价值研究^*[J]. 实用肝脏病杂志, 2022, 25(6): 861-864.
[11]	詹致远, 申洋, 王凡冰. 内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 865-868.
[12]	石青春, 潘立民, 布凡, 王永强, 关睿骞. 基于TCGA研究细胞坏死相关基因对肝细胞癌患者预后的影响^*[J]. 实用肝脏病杂志, 2022, 25(6): 869-872.
[13]	郑希彦, 杜飞, 林志群, 李瑞曦, 周正, 张广权, 周红, 何方平, 史宪杰. 肝细胞癌进展:代谢综合征相关危险因素研究[J]. 实用肝脏病杂志, 2022, 25(6): 877-880.
[14]	高正兴, 李广欣, 宋春青. 癌组织M6A甲基转移酶样蛋白3水平对手术切除后接受索拉非尼治疗的肝细胞癌患者预后的影响^*[J]. 实用肝脏病杂志, 2022, 25(6): 885-888.
[15]	沈一芃, 祝峻峰. 肝硬化并发自发性细菌性腹膜炎临床研究进展^*[J]. 实用肝脏病杂志, 2022, 25(6): 909-912.