磁共振弥散加权成像表观弥散系数、血清Wnt5b水平与乙肝相关性肝癌组织Ki-67表达密切相关

严翔.磁共振弥散加权成像表观弥散系数、血清Wnt5b水平与乙肝相关性肝癌组织Ki-67表达密切相关[J].内科急危重症杂志,2025,31(4):329-334

DOI：10.11768/nkjwzzzz20250408

中文关键词: 弥散加权成像无翅型MMTV整合位点家族成员5b 肝癌增殖细胞核抗原67

英文关键词:

基金项目:重庆市科卫联合医学科研项目（MSXM241)

作者	单位	E-mail
严翔	重庆市开州区人民医院	774835171@qq.com

摘要点击次数: 12

全文下载次数: 13

中文摘要:

摘要目的：探讨磁共振弥散加权成像（DWI）表观弥散系数（ADC）值、血清无翅型MMTV整合位点家族成员5b（Wnt5b）水平与乙肝相关性肝癌（HBV-HCC）组织增殖细胞核抗原67(Ki-67)表达的关系。方法：选取HBV-HCC患者180例，随机分为训练组126例和验证组54例，选取同期慢性乙型肝炎患者126例作为对照组，磁共振检测各组ADC值，免疫吸附试验检测各组患者血清Wnt5b水平。单因素和多因素Logistic回归分析HBV-HCC组织Ki-67表达的独立影响因素。绘制受试者工作特征（ROC）曲线分析ADC值、血清Wnt5b水平对HBV-HCC组织Ki-67表达的预测价值，并进行组外验证。结果：训练组、验证组ADC值低于对照组，血清Wnt5b水平高于对照组（P＜0.05）。酒精依赖程度、HBV-DNA载量、微血管侵犯、巴塞罗那临床肝癌分期、血清Wnt5b水平是训练组肝癌Ki-67表达的独立危险因素（OR分别为2.139、4.492、8.247、5.224、15.50，P均<0.05），分化程度、ADC值是训练组肝癌Ki-67表达的独立保护因素（OR分别为0.422，0.031，P均＜0.05）；训练组ADC值联合血清Wnt5b水平预测肝癌Ki-67表达的曲线下面积（AUC）优于两指标单独预测（Z=2.475，P=0.013；Z=2.745，P=0.006）；高风险阈值在0.20～0.82，联合预测的净受益率优于单独检测。验证组ADC值联合血清Wnt5b水平预测HBV-HCC组织Ki-67表达的AUC值为0.880，优于两指标单独预测（Z=2.119，P=0.034；Z=1.987，P=0.044），在阈值0.18～0.63范围内，联合预测的净受益率优于单独检测。结论：ADC值、血清Wnt5b水平与HBV-HCC组织Ki-67表达关系密切，术前检测ADC值、血清Wnt5b水平可为临床评估HBV-HCC组织Ki-67表达提供依据。

英文摘要:

Abstract Objective: To explore the relationship between the apparent diffusion coefficient (ADC) value of magnetic resonance diffusion-weighted imaging (DWI), the level of serum wingless-type MMTV integration site family member 5b (Wnt5b), and the expression of proliferating cell nuclear antigen 67(Ki-67) in hepatitis B-related liver cancer (HBV-HCC) tissues. Methods: A total of 180 patients with HBV-HCC were selected and randomly divided into a training group of 126 cases and a validation group of 54 cases. Meanwhile, 126 patients with chronic hepatitis B during the same period were selected as the control group. The ADC values of each group were detected by magnetic resonance, and the serum Wnt5b level was detected by immunoadsorption test. Univariate and multivariate Logistic regression analyses were used to analyze the independent influencing factors of Ki-67 expression in HBV-HCC tissues. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of ADC value and serum Wnt5b level for the expression of Ki-67 in HBV-HCC tissues, and out-of-group validation was conducted. Results: The ADC values and serum Wnt5b levels in the training group and the validation group were higher than those in the control group (P< 0.05). The degree of alcohol dependence, HBV-DNA load, microvascular invasion, Barcelona clinical liver cancer stage, and serum Wnt5b level were independent risk factors for Ki-67 expression in liver cancer in the training group (OR: 2.139, 4.492, 8.247, 5.224, and 15.50 respectively, all P< 0.05). The degree of differentiation and ADC value were independent protective factors for Ki-67 expression in liver cancer in the training group (OR: 0.422 and 0.031 respectively, both P< 0.05). The area under the curve (AUC) value of the combined ADC value of the training group and the serum Wnt5b level in predicting the expression of Ki-67 in liver cancer was better than that predicted alone (Z=2.475, P=0.013; Z=2.745, P=0.006); When the high-risk threshold was between 0.20 and 0.82, the net benefit rate of the combined prediction was superior to that of the individual detection. The AUC value of ADC value combined with serum Wnt5b level in the validation group for predicting Ki-67 expression in HBV-HCC tissues was 0.880, which was superior to the individual predictions of the two indicators (Z=2.119, P=0.034; Z=1.987, P=0.044). Within the threshold range of 0.18 to 0.63, the net benefit rate of the combined prediction was superior to that of the individual detection. Conclusion: The ADC value and serum Wnt5b level are closely related to the expression of Ki-67 in HBV-HCC tissues. Preoperative detection of ADC value and serum Wnt5b level can provide a basis for clinical evaluation of the expression of Ki-67 in HBV-HCC tissues.