HBV相关肝硬化结节癌变的MR增强特征与GPC-3、CD34表达的对应性研究  

MR enhancement features of multistep hepatocarcinogenesis in HBV-related cirrhotic livers: correlation with GPC-3 and CD34

作　　者：张琦[1] 李宏军[1] 李云芳[1] 张岩岩[1] 袁星星[1] 常静[1] 

机构地区：[1]首都医科大学附属北京佑安医院放射科,北京100069

出　　处：《首都医科大学学报》2016年第5期672-679,共8页Journal of Capital Medical University

基　　金：北京市医院管理局重点医学专业发展计划(ZYLX201511)~~

摘　　要：目的探索乙型肝炎病毒(hepatitis B virus,HBV)相关肝硬化结节癌变磁共振(magnetic resonance,MR)动态增强特征与免疫组织化学标志物磷脂酰肌醇蛋白聚糖-3(glypican-3,GPC-3)及CD34表达量之间的对应关系。方法收集44个乙型肝炎(以下简称乙肝)肝硬化患者中经病理证实的47个肝硬化结节纳入本研究,术前均行MR扫描,用软件将动态增强扫描序列自动生成时间-信号曲线,术后常规病理及免疫组织化学染色,观察GPC-3和CD34表达。结果 1)在47个结节中,GPC-3在早期肝癌(early hepatocellular carcinoma,e HCC),高级不典型增生结节(high grade dysplastic nodule,HGDN),低级不典型增生结节(low grade dysplastic nodule,LGDN)各组中的阳性率分别为78.9%、26.1%、0%,CD34强阳性表达在e HCC、HGDN及LGDN中分别为78.9%、56.5%、0%,差异均有统计学意义(P<0.05)。2)e HCC、HGDN、LGDN的MR动态灌注时间-信号曲线特点分别倾向为陡升型、缓升型、平行型。GPC-3阳性的结节和阴性的结节两者之间时间信号曲线差异有统计学意义(P<0.05)。CD34强阳性、弱阳性、阴性的e HCC之间时间-信号曲线差异有统计学意义(P<0.05)。结论 1)MR时间-信号曲线特点对e HCC及HGDN的鉴别诊断有一定的价值。2)GPC-3表达阳性具有提示结节良恶性的诊断价值,同时MR时间-信号曲线表现为陡升型。3)CD34表达量与MR增强时间-信号曲线呈正相关。Objective To study the correlation between MR（ magnetic resonance） enhancement features and GPC-3（ glypican- 3）and CD34 expression in hepatic B Virus（ HBV）-related liver cirrhosis nodules. Methods This retrospective study collected 47 pathology proven nodules in 44 HBV-related liver cirrhosis patients,who underwent MRI and made the time-signal curve of dynamic enhancement,and we also evaluated the immunohistochemical biomarkers levels of GPC-3 and CD34. Results 1） In the 47 nodules,GPC-3 positive rate in early hepatocellular carcinoma（ e HCC）,high grade dysplastic nodule（ HGDN）,low grade dysplastic nodule（ LGDN） were78. 9%,26. 1% and 0%,respectively（ P = 0. 000）,CD34 positive rates were respectively 78. 9%,56. 5%,0%,and the difference was statistically significant（ P = 0. 005）. 2） The MR time-signal features at different stage of nodules,GPC-3 positive and negative nodules,CD34 strongly positive and weakly positive and negative nodules,were statistically significant（ P〈0. 05）. Conclusion 1） MR time-signal curve has a certain differential diagnostic value for early stage of HCC. 2） GPC-3 is a highly specific biomarker for the malignance,while MR time-signal curve inclined to show rapid rise type. 3） CD34 expression was positively correlated with MR timesignal curve.

关 键 词：肝硬化 不典型增生结节 早期肝癌 磁共振成像 GPC-3 CD34 

分 类 号：R445.2[医药卫生—影像医学与核医学] R575.2[医药卫生—诊断学]