炎症预后指数联合双源CT灌注成像对肝癌TACE术后早期反应预测价值的临床研究  

Clinical value of inflammatory prognostic index combined with dual-source CT perfusion imaging in predicting early response of hepatocellular carcinoma after transcatheter hepatic artery chemoembolization

作　　者：毕孝杨 邱瑞珍 杨福军 杨巧飞 唐艳隆 BI Xiaoyang;QIU Ruizhen;YANG Fujun;YANG Qiaofei;TANG Yanlong(Clinical Medical School of Dali University,Dali,Yunnan Province 671000,China)

机构地区：[1]大理大学临床医学院,云南大理671000 [2]大理市第二人民医院 [3]大理大学第一附属医院放射科

出　　处：《介入放射学杂志》2025年第1期37-47,共11页Journal of Interventional Radiology

基　　金：云南省教育厅科学研究基金项目(2023Y0987);大理大学临床医学院学科队伍建设重点项目(DFYZD2022-04);云南省省校合作地方高校联合专项项目(202001BA070001-149);云南省卫生健康委员会医学后备人才培养计划(H-2018010)。

摘　　要：目的探究炎症预后指数联合双源CT灌注成像对肝癌TACE术后早期反应的预测价值。方法前瞻性收集大理大学第一附属医院2022年11月至2023年11月期间首次进行TACE治疗且符合纳入标准的25例HCC患者,在患者TACE术前及术后30~40 d进行CT灌注扫描并收集患者血常规、血生化资料,根据术后增强CT图像,采用改良实体肿瘤标准评估肿瘤早期反应,将完全缓解(CR)、部分缓解(PR)的患者归所有类为有效组(n=14),疾病稳定(SD)、疾病进展(PD)的患者为无效组(n=11)。分析不同反应组CT灌注成像参数和炎症参数的差异,探究术前CT灌注出血和炎症参数对术后早期反应的预测价值,并在最大约登指数处取截断值,单因素、多因素分析CTPI及炎症参数、临床特征对预后的影响,用R软件构建列线图预测模型。结果TACE术后肝动脉灌注量(ALP)、肝动脉灌注指数(HPI)、血流量(BF)、血容量(BV)明显低于手术前(P<0.05),TACE术后门静脉灌注量(PVP)明显高于术前(P<0.05),TACE手术前后平均通过时间(MTT)、流量提取乘积(FED)、C反应蛋白(CRP)、白蛋白(ALB)、中性粒细胞/淋巴细胞比值(NLR)、炎症预后指数(IPI)差异无统计学意义(P>0.05);有效组TACE术前ALP、BF、FED明显高于无效组,有效组术前CRP、IPI明显低于有效组(P<0.05),有效组和无效组TACE术前PVP、HPI、MTT、BV、ALB、NLR差异无统计学意义(P>0.05);在有效组中,TACE术前ALP、HPI、BF、BV、FED明显高于术后(P<0.05),术前PVP明显低于术后(P<0.05),MTT、CRP、ALB、NLR、IPI在TACE手术前后差异无统计学意义(P>0.05),在无效组中,TACE术前HPI明显高于术后(P<0.05),ALP、PVP、BF、BV、MTT、FED、ALB、CRP、NLR、IPI在TACE手术前后差异无统计学意义(P>0.05);术前ALP、BF、BV、FED、CRP、IPI对TACE术后早期反应的预测价值较高(P<0.05),AUC值分别为0.831、0.779、0.740、0.753、0.779、0.805,最佳截断值分别为33.280 mL/(100 mL·min)、61.860 mL/(10Objective To explore the clinical value of inflammatory prognostic index combined with dual-source CT perfusion imaging in predicting early response of hepatocellular carcinoma(HCC) after transcatheter hepatic artery chemoembolization(TACE).Methods A total of 25 patients with HCC,who met the inclusion criteria and received initial TACE at the First Affiliated Hospital of Dali University of China from November 2022 to November 2023,were prospectively collected.CT perfusion scan was performed before TACE as well as in 30-40 days after TACE,and blood routine and blood biochemical data were collected.The modified Response Evaluation Criteria in Solid Tumors(mRECIST) was used to evaluate postoperative enhanced CT manifestations.Patients obtaining complete remission(CR) or partial remission(PR) were classified as effective group(n=14),and patients obtaining stable disease(SD) or progression disease(PD) were classified as ineffective group(n=11).The differences in CT perfusion imaging parameters and inflammatory parameters between the two groups were analyzed, and the predictive values of preoperative CT perfusion imaging parameters and inflammatory parameters for postoperative early response of HCC were evaluated.The cutoff value was taken at the maximum Youden index.Univariate analysis and multivariate analysis were used to analyze the effect of CT perfusion imaging parameters, inflammatory parameters and clinical features on the prognosis.The nomogram prediction model was constructed by using R software.Results The post-TACE arterial liver perfusion(ALP),hepatic perfusion index(HPI),blood flow(BF) and blood volume(BV) were significantly lower than their pre-TACE values(all P<0.05).Afer TACE portal vein perfusion(PVP) was obviously higher than that before operation(P<0.05).No statistically significant differences in the mean transit time(MTT),flow extraction product(FED),C-reactive protein(CRP),albumin(ALB),neutrophil/lymphocyte ratio(NLR) and inflammatory prognosis index(IPI) existed between the pre-TACE values and p

关 键 词：肝癌 CT灌注成像 肝动脉化疗栓塞 列线图 

分 类 号：R735.7[医药卫生—肿瘤]