子宫内膜癌动态增强磁共振成像与血清甲壳质酶蛋白40表达的相关性研究

Study on the correlation between dynamic contrast-enhanced MRI and the expression of serum chitin enzymes protein 40 in endometrial carcinoma

目的:探究子宫内膜癌动态增强磁共振成像(DCE-MRI)与血清甲壳质酶蛋白40(YKL-40)表达的相关性。方法:选取在医院妇产科就诊的80例子宫内膜癌患者,均行DCE-MRI检查,并检测血清YKL-40水平;以手术病理结果为“金标准”,评估DCE-MRI和检测血清YKL-40水平的子宫内膜癌分期及其诊断价值;分析子宫内膜癌DCE-MRI与血清YKL-40表达的相关性。结果:MRI动态增强诊断Ⅰa期46例,Ⅰb期13例,Ⅱ期17例,Ⅲ期4例;浅肌层浸润53例,深肌层浸润27例,其诊断的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为86.96%、87.72%、87.50%、74.07%和94.34%;无宫颈间质浸润63例,宫颈间质浸润17例,其诊断的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为65.00%、93.33%、86.25%、76.47%和88.89%;无淋巴结转移68例,有淋巴结转移12例,其诊断的灵敏度、特异度、准确率、阳性预测值及阴性预测值分别为66.67%、96.92%、91.25%、83.33%和92.65%。子宫内膜癌Ⅲ期患者血清YKL-40水平显著高于Ⅱ期、Ⅰb期及Ⅰa期,差异有统计学意义(F=74.568,P<0.05);深肌层浸润患者血清YKL-40水平显著高于浅肌层浸润(t=9.709,P<0.05);宫颈间质浸润患者血清YKL-40水平显著高于无宫颈间质浸润(t=8.825,P<0.05);淋巴结转移患者血清YKL-40水平显著高于无淋巴结转移(t=12.688,P<0.05)。结论:DCE-MRI对子宫内膜癌患者分期、肌层浸润深度、宫颈间质浸润及淋巴结转移具有较好的诊断价值,且与血清YKL-40表达存在一定相关性。

Objective: To investigate the correlation between dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) and the expression of serum chitin enzymes protein 40(YKL-40) in endometrial carcinoma. Methods: A total of 80 patients with endometrial cancer who admitted to the department of obstetrics and gynecology of hospital were selected. All of them underwent DCE-MRI examination and serum YKL-40 detection. The pathological result was used as golden standard to assess the DCE-MRI staging for endometrial cancer and the diagnostic value of DCEMRI, and the serum YKL-40 levels of patients were detected. In addition, the correlation between DCE-MRI and serum YKL-40 expression in endometrial cancer was analyzed. Results: As DCE-MRI diagnosis, the Ⅰa stage, Ⅰb stage, Ⅱstage and Ⅲ stage were 46 cases, 13 cases, 17 cases and 4 cases, and the superficial myometrial invasion and deep myometrial invasion were 53 cases and 27 cases, respectively. And the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of DEC-MRI were 86.96%, 87.72%, 87.50%, 74.07% and 94.34% for them, respectively. And there were 63 cases without cervical stromal infiltration and 17 cases with cervical stromal infiltration by DCE-MRI, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of that were 65.00%, 93.33%, 86.25%, 76.47% and 88.89% for them, respectively. And there were 68 cases without lymph node metastasis and 12 cases with lymph node metastasis, and the sensitivity, specificity, accuracy,positive predictive value and negative predictive value of DCE-MRI were 66.67%, 96.92%, 91.25%, 83.33% and 92.65%for them, respectively. In addition, the serum YKL-40 level in patients with stage III was significantly higher than that in patients with stage Ⅱ, stage Ib and stage Ia(F=74.568, P<0.05). And the serum YKL-40 level in patients with deep myometrial invasion was significantly higher than that in patients with superficial myometrial invasion(t=9.709,P<0.05). And the serum YKL-40 level in patients with cervical stromal infiltration was significantly higher than that in patients without cervical stromal infiltration(t=8.825, P<0.05). The serum YKL-40 level in patients with lymph node metastasis was significantly higher than that in patients without lymph node metastasis(t=12.688, P<0.05).Conclusion: DCE-MRI has favorable diagnostic value for endometrial carcinoma staging, deep myometrial invasion,cervical stromal invasion and lymph node metastasis. It has a certain of correlation with serum YKL-40 expression.