血清miR-378a-5p水平联合微血流成像的超声多模态检查对肝癌疾病进展与微血管侵犯的评估价值

The Value of Multimodal Ultrasound Examination of Serum Mir-378A-5p Level Combined with Microflow Imaging for The Evaluation of Liver Cancer Disease Progression and Microvascular Invasion

目的探讨血清miR-378a-5p水平联合微血流成像的超声多模态检查对肝癌疾病(HCC)进展与微血管侵犯(MVI)的评估价值。方法选取HCC患者100例作为研究对象,根据诊断结果分为MVI组(n=60)、非MVI组(n=40)。应用实时荧光定量PCR法检测血清miR-378a-5p mRNA相对表达量;应用Philips彩超诊断仪进行微血流成像的超声多模态检查。分析HCC不同分期血清指标和超声表现差异;将MVI的危险因素进行单因素分析,将甲胎蛋白(AFP)、癌胚抗原(CEA)、miR-378a-5p进行多因素Logistic回归分析,分析血清miR-378a-5p、联合微血流成像的超声多模态检查单独及联合检测对MVI预测价值。结果HCCⅠ期、Ⅱ期、Ⅲ期动脉相、门脉相造影及血清miR-378a-5p水平比较,差异具有统计学意义(P<0.05);单因素分析显示,两组性别、年龄、体质量、肿瘤位置比较,差异无统计学意义(P>0.05);MVI组包膜破损、无包膜、微血流Ⅱ级、Ⅲ级、门脉相高增强、肿瘤不光滑边缘、AFP、CEA、miR-378a-5p、SBP、DBP高于非MVI组,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示,血清CEA、微血流分级、miR-378a-5p为发生MVI的独立危险因素(P<0.05);ROC结果显示,血清miR-378a-5p、联合微血流成像的超声多模态检查单独预测MVI的最佳截断点分别为2.655 ng/mL、44.35μg/mL,单独及联合预测MVI预后不良的AUC分别为0.731、0.697、0.852。结论HCC患者不同分期超声表现及血清miR-378a-5p水平不同,且MVI患者血清miR-378a-5p低表达,血清miR-378a-5p联合微血流成像的超声多模态检查对早期MVI检测具有较高诊断价值。

Objective To investigate the value of multimodal ultrasound examination of serum Mir-378A-5p combined with microflow imaging for the evaluation of progression of hepatocellular carcinoma(HCC)and microvascular invasion(MVI).Methods 100 HCC patients were selected as the subjects of this study,and were divided into MVI group(n=60)and non-MVI group(n=40)according to the diagnosis results.The relative expression of serum miR-378a-5p mRNA was detected by real-time fluorescence quantitative PCR.The risk factors of MVI were analyzed by univariate analysis,and AFP,CEA and miR-378a-5p were analyzed by multivariate Logistic regression analysis.The predictive value of serum miR-378a-5p and ultrasonic multimodal examination combined with microflow imaging alone and in combination was analyzed.Results There were statistically significant differences in arterial and portal angiography and serum miR-378a-5p levels of HCC stageⅠ,ⅡandⅢ(P<0.05).Univariate analysis showed that there were no significant differences in gender,age,body weight and tumor location between the two groups(P>0.05).MVI group was significantly higher than non-MVI group in terms of capsule damage,no capsule,single-nodular type,multi-nodular type,tumor maximum diameter,non-smooth edge,AFP,CEA,Mir-378A-5p,SBP and DBP,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that serum CEA,ultrasound multimodal examination of microflow imaging and Mir-378A-5p were independent risk factors for MVI(P<0.05).ROC results showed that the optimal cut-off points of serum miR-378a-5p and ultrasonic multimode examination combined with microflow imaging were 2.655 ng/mL and 44.35μg/mL,respectively,and the AUC of poor prognosis of MVI were 0.731,0.697 and 0.852,respectively.Conclusion The ultrasound manifestations and serum miR-378a-5p levels are different in DIFFERENT stages of HCC patients,and the low expression of serum miR-378a-5p in MVI patients.Ultrasound multimodal examination of serum Mir-378A-5P combined with microflow imaging has high diagnostic value for early DETECTION of MVI.