临床及影像学特征在乏脂性血管平滑肌脂肪瘤与肾细胞癌(≤3 cm)鉴别中的作用

Clinical and imaging features in the differential diagnosis between fat-poor angiomyolipoma and renal cell carcinoma(≤3 cm)

目的:探讨小的(≤3 cm)乏脂性血管平滑肌脂肪瘤(angiomyolipoma,AML)和肾细胞癌(renal cell carcinoma,RCC)的血液生化学和影像学各项指标在两者鉴别诊断中的作用。方法:回顾性分析2016年9月—2022年3月广东省人民医院收治的107例患者的围手术期血液生化学和CT影像学的资料,其中乏脂性AML组20例,RCC组87例,对2组之间可能存在的危险因素进行单因素和多因素的logistic回归分析,并选取独立危险因素进行受试者工作特征(ROC)曲线分析。结果:男69例,女38例;年龄21~76岁,平均(52.1±12.5)岁;左肾46例,右肾61例;肿瘤直径1~3 cm,平均(2.2±0.6)cm。2组比较,乏脂性AML组体重指数(bodymass index,BMI)、血白细胞(white blood cell,WBC)、碱性磷酸酶(alkaline phosphatase,ALP)、低密度脂蛋白(low density lipoprotein,LDL)和肿瘤标准化非均质比(standardized heterogeneous ratio,SHR)显著降低,而高密度脂蛋白(high density lipoprotein,HDL)显著上升(P<0.05)。多因素logistic分析示BMI、HDL和SHR是鉴别乏脂性AML和RCC的独立危险因素。ROC曲线示BMI、HDL和SHR的阈值分别为22.374 kg/m^(2)(灵敏度为75.0%,特异度为67.8%)、1.17 mmol/L(灵敏度为70.0%,特异度为71.9%)和202.007(灵敏度为65.0%,特异度为63.2%)。结论:当SHR<202.007、BMI<22.374 kg/m^(2)、HDL>1.17 mmol/L时,小的肾脏肿物(≤3 cm)更加倾向于诊断为乏脂性AML。

Objective To evaluate the role of hematobiochemical and imaging indicators in the differential diagnosis between small(≤3 cm)fat-poor angiomyolipoma(AML)and renal cell carcinoma(RCC).Methods Perioperative blood biochemistry and CT imaging data of 107 patients from September 2016 to March 2022 were analyzed,including 20 fat-poor AML patients and 87 RCC patients.Univariate and multivariate logistic regression analysis were used to analyze the risk factors between the two groups.The independent risk factors were selected for ROC curve analysis.Results There were 69 males and 38 females,46 left kidneys and 61 right kidneys.Patients'age was 21-76 years([52.1±12.5]years).The tumor size was 1-3 cm([2.2±0.6]cm).Between the two groups,BMI,WBC,alkaline phosphatase(ALP),low-density lipoprotein(LDL)and tumor standardized heterogeneous ratio(SHR)were significantly decreased in the fat-poor AML group,while high density lipoprotein(HDL)was significantly increased(P<0.05).Multivariate logistic analysis showed that BMI,HDL and SHR were independent risk factors for identifying fat-poor AML and RCC.The ROC curve showed that the threshold values of BMI,HDL and SHR were 22.374 kg/m^(2)(sensitivity 75.0%,specificity 67.8%),1.17 mmol/L(sensitivity 70.0%,specificity 71.9%),and 202.007(sensitivity 65.0%,specificity 63.2%),respectively.Conclusion Small renal masses(≤3 cm)were more likely to be diagnosed with fat-poor AML,when SHR<202.007,BMI<22.374 kg/m^(2)and HDL>1.17 mmol/L.