MRI联合血清AFP和IL-33对原发性肝细胞癌的诊断价值

Diagnostic value of MRI combined with serum AFP and IL-33 in primary hepatocellular carcinoma

目的:探讨MRI参数联合血清AFP和IL-33对原发性肝细胞癌(HCC)的诊断价值。方法:纳入2020年1月1日至2024年4月1日广东省中医院收治的HCC、肝内胆管癌及良性肝病患者,其中HCC患者106例,肝内胆管癌患者58例,良性肝病患者179例(包括肝血管瘤患者59例、肝囊肿患者62例、肝局灶性结节样增生患者58例)。所有患者均行MRI检查及血清AFP、IL-33水平检测,比较各组患者MRI检查转运常数(K^(trans))、速率常数(K_(ep))、血管外细胞外间隙体积百分比(V_(e))及血清AFP、IL-33水平。采用受试者工作特征曲线(ROC)分析上述指标单独或联合检测对HCC的诊断效能。结果:HCC组K^(trans)、K_(ep)、V_(e)水平均明显高于肝内胆管癌组和良性肝病组,差异具有统计学意义(P<0.001);HCC组血清AFP、IL-33水平均明显高于肝内胆管癌组和良性肝病组,差异具有统计学意义(P<0.001);ROC曲线分析结果显示,MRI参数K^(trans)、K_(ep)、V_(e)诊断HCC的最佳截断值分别为0.38 mL/min、1.32 mL/min和0.36%;AFP、IL-33诊断HCC的最佳截断值分别为44.52ng/mL和100.81 ng/mL;K^(trans)、K_(ep)、V_(e)、AFP和IL-33诊断HCC的灵敏度分别为74.58%、74.58%、71.19%、77.12%和77.97%,特异度分别为74.53%、77.36%、73.58%、74.53%和74.53%;K^(trans)、K_(ep)、V_(e)、AFP和IL-33联合检测诊断HCC的AUC为0.959(95%CI:0.936~0.982),预测灵敏度和特异度分别为91.53%和90.57%。结论:K^(trans)、K_(ep)、V_(e)、AFP和IL-33联合检测对HCC具有较好的诊断效能,能为HCC的诊断提供一定的临床参考价值。

Objective:To explore the diagnostic value of MRI parameters combined with serum AFP and IL-33 in primary hepatocellular carcinoma(HCC).Methods:Patients with HCC,intrahepatic cholangiocarcinoma or benign liver disease admitted to Guangdong Hospital of Traditional Chinese Medicine from January 1,2020 to April 1,2024 were included.106 cases of HCC,58 cases of intrahepatic cholangiocarcinoma,179 cases of benign liver disease group(59 cases of hepatic hemangioma,62 cases of hepatic cyst,58 cases of and hepatic focal nodular hyperplasia were finally included).All patients were examined by MRI and the levels of AFP and IL-33 were detected.The transport constant(K^(trans)),rate constant(K_(ep)),extracellular space volume percentage(V_(e)),and serum AFP and IL-33 levels were compared between the two groups.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of the above indexes alone or in combination for HCC.Results:The levels of K^(trans),K_(ep) and V_(e) in HCC group were significantly higher than those in intrahepatic cholangiocarcinoma and benign liver disease group,and the difference was statistically significant(P<0.001).The levels of serum AFP and IL-33 in HCC group were significantly higher than those in intrahepatic cholangiocarcinoma and benign liver disease group,and the difference was statistically significant(P<0.001).ROC curve analysis showed that the optimal cut-off values of MRI parameters K^(trans),K_(ep) and V_(e) in the diagnosis of HCC were 0.38 mL/min,1.32 mL/min and 0.36%.The optimal cut-off values of AFP and IL-33 for HCC diagnosis were 44.52 ng/mL and 100.81 ng/mL.The sensitivity of K^(trans),K_(ep),V_(e),AFP and IL-33 in the diagnosis of HCC were 74.58%,74.58%,71.19%,77.12%and 77.97%,and the specificity was 74.53%,77.36%,73.58%,74.53%and 74.53%.The AUC of K^(trans),K_(ep),V_(e) combined with AFP and IL-33 in the diagnosis of HCC was 0.959(95%CI:0.936-0.982),and the predictive sensitivity and specificity were 91.53%and 90.57%.Conclusion:The combined detection of K^(trans),K_(ep),V_(e),AFP,and IL-33 show good diagnostic efficacy of HCC,which may provide certain clinical reference value for HCC diagnosis.