原发性肝细胞癌的动态CT成像表现与细胞DNA增殖水平的关系及其临床意义

Relationship Between the Appearance of Dynamic Enhanced CT and the Level of DNA Proliferation in PHCC and Its Clinical Value

【目的】探讨原发性肝细胞癌的动态CT增强（DECT）表现与细胞DNA增殖水平的关系及其临床意义。【方法】原发性肝细胞癌（PHCC）35例，根据动态CT增强（DECT）表现及衰减快慢表现分为A、B两组，A组为“快速增强，快速衰减”，B组为“快速增强，慢速衰减”。记录各肿瘤结节的CT增强始增时间，峰值时间，始退时间及增强持续时间。所有病例均在行CT动态增强后行手术切除，术后标本送病理组织学检查与流式细胞术检查。分别记录各肿瘤结节细胞增殖的DNA各期比率以及增殖系数PI，计算各组间DNA非整倍体（异倍体）干系的百分比率。【结果】动态CT增强（DECT）检查，始增时间及峰值时间A组与B组间均无显著性差异（P〉0．05）；但始退时间A组明显短于B组（P〈0．05）；增强持续时间A组明显短于B组，两组间差异具有统计学意义（P〈0．05）。肿瘤细胞DNA分析，A组肝癌细胞表现为高增值的S期比率及增殖系数显著高于B组（P〈0．05）。A组异倍体峰出现率高达53．57％（15／28），B组则无一例出现异倍体峰。【结论】原发性肝细胞癌（PHCC）动态CT增强（DECT）表现与肿瘤细胞DNA增殖水平具有相关性，其增强持续时间与DNA的S期比率及增殖系数呈负相关关系。因此，动态CT增强（DECT）持续时间在一定程度上反映了原发性肝细胞癌的生物学特性与恶性度。对肝癌临床治疗方案选择及预后有一定的指导意义。

[Objective]To investigate the relationship between the appearance of dynamic enhanced CT（DECT） of PHCC and the level of DNA proliferation in primary hepatocellular carcinoma（PHCC） and its clinical value. [Methods] Thirty five PHCC patients were examined by dynamic enhanced CT （DECT）. The patients were divided into typical group （group A） and untypical group （group B） according to the manifestations of DECT and the speed of attenuation. Group A was ＂fast enhanced and fast attenuated＂ group and group B was ＂fast enhanced and slow attenuated＂ group. The contrast agent enhanced beginning time, peak time, wash-out time and persistence time in every tumor nodule were recorded. All PHCC tissues were acquired by operations and the DNA content of each tumor node was examined by flow cytometry （FCM）. The rates of DNA content and the proliferation index （PI） in the different period were recorded and DNA aneuploid percentages of different groups were counted. [Results]In examination of dynamic enhanced CT, the beginning time and peak time were no significant difference between group A and group B（ P 〉0.05）. The wash-out time and persistence time of group A were all distinctly shorter than that of group B, which was with statistical significant difference （ P 〈0.05）. In DNA FCM examination, the PHCC cells of group A showed a high S phase fraction and the PI was much higher than that of group B （ P 〈0.05）. In all 35 PHCC tumor nodes, the correlation between tumor cell S phase fraction and proliferation index had statistical significance （ P 〈0.05）. The appearance rate of aneuploid tumor cells arrived at 53.57% （15/28） in group A, but there was no aneuploid cell in group B. [Conclusion] There is correlation between DECT characterization and DNA proliferation in PHCC. The correlation between enhanced persistence time and tumor cell S phase fraction as well as PI of DNA is negative. Therefore, the persistence time of DECT may reflect the biology features and malignant grade of PHCC to a certain extent. This may be helpful for the patients with PHCC in prognosis and treatment choice.