体素内不相干运动联合生物标志物在非小细胞肺癌疗效评价中的应用  

Application of intra-voxel incoherent motion combined with biomarker in the evaluation of efficacy of non-small cell lung cancer

作　　者：韩霞[1] 陈英海 杜春娟[1] 刘志冰[1] 李绵利[1] 刘长民[1] HAN Xia;CHEN Yinghai;DU Chunjuan;LIU Zhibing;LI Mianli;LIU Changmin(Department of Oncology,Binzhou Medical University Hospital,Binzhou 256603,Shandong,P.R.China;Tianjin 120 Emergency Center,Tianjin 300000)

机构地区：[1]滨州医学院附属医院肿瘤科,山东滨州256603 [2]天津市急救中心,天津300000

出　　处：《滨州医学院学报》2020年第3期172-177,共6页Journal of Binzhou Medical University

基　　金：滨州医学院科技计划(BY2015KJ31)。

摘　　要：目的研究磁共振体素内不相干运动(IVIM)各参数及血清血管内皮生长因子(VEGF)、缺氧诱导因子-1αL(HIF-1α)在评价晚期非小细胞肺癌(NSCLC)放化疗疗效中的作用。方法59例晚期NSCLC行放化疗治疗,治疗前后分别行IVIM检查并通过后处理软件获取参数值,检测治疗前后血清VEGF、HIF-1α水平。治疗结束1~3月根据实体瘤疗效评价标准RECIST 1.1将肿瘤对放化疗的治疗反应评价为完全缓解(CR)、部分缓解(PR)、病变稳定(SD)和病变进展(PD),CR、PR归为疗效敏感组;SD、PD归为疗效不敏感组。比较两组间治疗前后各参数值的变化,采用ROC曲线分析各参数判断晚期NSCLC放化疗疗效的效能,并确定最佳临界值。结果NSCLC患者血清VEGF、HIF-1α水平明显高于健康志愿者组(P<0.01)。IVIM参数值及血清VEGF、HIF-1α水平与年龄、分期及病理类型存在相关性(P<0.05)。治疗前D值、治疗前f值、D变化值、治疗后VEGF、VEGF变化值、治疗后HIF-1α值、HIF-1α变化值在预测近期疗效有一定价值(P<0.05)。D变化值、HIF-1α变化值诊断界值分别取0.29×10^-3 mm^2/s、0.29 ng/mL时,其预测放化疗疗效效能最佳。VEGF、HIF-1α联合IVIM参数能提高预测放化疗疗效的效能。结论VEGF、HIF-1α单独或联合IVIM参数均可作为早期预测NSCLC放化疗疗效的有效指标。Objective To investigate the role of IVIM parameters and serum VEGF and HIF-1αin evaluating the efficacy of chemoradiotherapy for advanced non-small cell lung cancer(NSCLC).Methods Fifty-nine cases of advanced NSCLC were treated with chemoradiotherapy.IVIM was performed before and after treatment,and the parameters before and after treatment were obtained by post-treatment software,serum VEGF and HIF-1αlevels were obtained before and after treatment.Response to chemoradiotherapy was assessed as complete response(CR),partial response(PR),disease stability(SD)and disease progression(PD)according to RECIST 1.1.CR and PR were classified as curative effect sensitive group.SD and PD were classified as efficacy insensitivity group.The independent sample T test was used to compare the changes of each parameter value before and after treatment between the two groups,and the ROC curve was used to analyze each parameter to judge the evaluation efficacy of concurrent chemoradiotherapy for advanced NSCLC,and the optimal threshold was determined.Results Serum VEGF and HIF-1αin NSCLC patients were significantly higher than those in healthy volunteers(P<0.01).IVIM parameters and serum VEGF and HIF-1αlevels were correlated with age,stage and pathological type(P<0.05).D value,f value,D change value,VEGF,VEGF change value,HIF-1αvalue,HIF-1αchange value after treatment have certain value in predicting short-term efficacy(P<0.05).When the change value of D and the change value of HIF-1αwere 0.29×10^-3mm^2/s and 0.29ng/mL,respectively,the predictive efficacy of chemoradiotherapy was the best.VEGF and HIF-1αcombined with IVIM parameters can improve the prediction of chemoradiotherapy efficacy.Conclusion VEGF and HIF-1αalone or in combination with IVIM parameters can be used as effective indicators for early prediction of NSCLC chemoradiotherapy efficacy.

关 键 词：肺癌 磁共振成像 体素内不相干运动 VEGF HIF-1Α 

分 类 号：R734[医药卫生—肿瘤]