MRI联合血清GPC3水平鉴别肝脏结节性增生病灶临床应用价值研究

Diagnostic value of MRI and serum GPC3 levels in patients with nodular regenerative hyperplasia

目的探究磁共振成像(MRI)联合血清磷脂酰肌醇蛋白聚糖3(GPC3)水平在鉴别诊断肝脏结节性增生(NRH)病灶方面的临床价值。方法2016年3月~2019年8月我院诊治的NRH患者79例,经手术组织病理学检查结果为局灶性结节性增生(FNH)25例,肝细胞腺瘤(LCA)18例,异型增生结节(DN)20例和肝细胞癌(HCC)16例。采用ELISA法检测血清GPC3水平,使用西门子Avanto 3.0 T超导MRI检查设备和ADW 4.6后处理工作站行MRI检查。应用受试者工作特征曲线(ROC)分析MRI联合血清GPC3对四种病变的鉴别诊断价值。结果HCC组血清GPC3水平为(2.2±0.4)ng/ml,显著高于FNH组或LCA组【分别为(1.0±0.2)ng/ml和(1.2±0.2)ng/ml,P<0.05】,而与DN组血清GPC3水平【(1.8±0.3)ng/ml,P>0.05】比,无显著性差异;MRI鉴别HCC、DN、FNH与LCA的准确率分别为88.0%(22/25)、88.9%(16/18)、70.0%(14/20)和75.0%(12/16),无显著性差异(P>0.05);MRI联合血清GPC3水平鉴别诊断HCC的AUC为0.760,显著大于诊断其他三种病变(分别为0.610、0.611和0.614,P<0.05)。结论MRI联合血清GPC3水平检测诊断HCC具有较大的临床应用价值,值得进一步验证。

Objective The aim of this study was to investigate the diagnostic value of magnetic resonance imaging(MRI)and serum glypican 3(GPC3)levels in patients with nodular regenerative hyperplasia(NRH).Methods A total of 79 patients with NRH were admitted to our hospital between March 2016 and August 2019.Serum GPC3 levels were detected by ELISA,and all patients underwent MRI scan.After finishing the check-up,all patients received hepatectomy.The differential value of MRI and serum GPC3 levels for the four types of hepatic lesions was analyzed by receiver operating characteristic(ROC)curves.Results The post-operational histopathological examination showed focal nodular hyperplasia(FNH)in 25 cases,liver cell adenoma(LCA)in 18 cases,dysplasia nodule(DN)in 20 cases and hepatocellular carcinoma(HCC)in 16 cases;serum GPC3 level in patients with HCC was(2.2±0.4)ng/ml,significantly higher than(1.0±0.2)ng/ml in patients with FNH,or(1.2±0.2)ng/ml in patients with LCA(P<0.05),while serum GPC3 level in patients with DN was(1.8±0.3)ng/ml,not significantly different compared to that in patients with HCC(P>0.05);the accuracy by MRI in diagnosing HCC,DN,FNH and LCA were 88.0%(22/25),88.9%(16/18),70.0%(14/20)and 75.0%(12/16),not significantly different(P>0.05);the AUC of MRI and serum GPC3 level combination in diagnosing HCC was 0.760,significantly higher than in other three hepatic lesions(0.610,0.611 and 0.614,respectively,P<0.05).Conclusion MRI and serum GPC3 level combination in distinguishing hepatic NRH is promising and efficacious,which warrants further clinical investigations.