DSC-PWI定量参数联合血清α-HBDH和MMP-9对肺癌脑转移的诊断价值

doi:10.3760/cma.j.cn441417-20240805-14027

摘要/Abstract

摘要：

目的　探讨动态磁敏感对比增强灌注加权成像（DSC-PWI）定量参数联合血清α-羟丁酸脱氢酶（α-HBDH）和基质金属蛋白酶-9（MMP-9）对肺癌脑转移的诊断价值。方法　采用前瞻性、单中心、随机研究，选取2019年6月至2023年6月在榆林市第一医院接受治疗的晚期肺癌疑似脑转移患者116例，其中男72例、女44例，年龄（61.93±9.21）岁。以病理学检查为脑转移诊断的金标准，将研究对象分为脑转移组和肺癌组，所有患者接受DSC-PWI检查，获取脑血容量（CBV）、脑血流量（CBF），并对肿瘤内异常灌注区与对侧镜像区的灌注参数进行标准化，获取平均局部脑血容量（rCBV）、平均局部脑血流量（rCBF）。比较两组DSC-PWI定量参数与α-HBDH、MMP-9水平，分析肺癌脑转移的危险因素，评价DSC-PWI定量参数、α-HBDH、MMP-9对肺癌脑转移的诊断价值。统计学分析采用t检验、χ²检验。结果　经病理学诊断，116例晚期肺癌疑似脑转移患者中确诊脑转移84例。脑转移组和肺癌组患者的rCBV分别为2.54±0.72、0.97±0.31，rCBF分别为2.31±0.75、1.16±0.41，血清α-HBDH分别为（176.31±38.54）U/L、（141.09±35.16）U/L，MMP-9分别为（114.35±26.98）ng/L、（98.51±17.04）ng/L，两组比较差异均有统计学意义（均P<0.05）。rCBV（OR=3.691，95%CI：1.630～8.357）、rCBF（OR=3.647，95%CI：1.611～8.258）、α-HBDH（OR=4.104，95%CI：1.812～9.292）、MMP-9（OR=3.955，95%CI：1.747～8.954）是肺癌脑转移的危险因素（均P<0.05）。rCBV、rCBF、α-HBDH、MMP-9及联合诊断肺癌脑转移的灵敏度分别为0.82、0.73、0.71、0.80、0.89，特异度分别为0.78、0.77、0.69、0.59、0.91，曲线下面积分别为0.781、0.725、0.731、0.739、0.885。结论　rCBV、rCBF、α-HBDH、MMP-9与肺癌脑转移有关，可用于辅助诊断肺癌脑转移，诊断效能良好。

关键词: 肺癌, 脑转移, 动态磁敏感对比增强灌注加权成像, α-羟丁酸脱氢酶, 基质金属蛋白酶-9

Abstract:

Objective　To explore the diagnostic value of dynamic magnetic sensitive contrast-enhanced perfusion weighted imaging (DSC-PWI) quantitative parameters combined with serum α-hydroxybutyrate dehydrogenase (α-HBDH) and matrix metalloproteinase-9 (MMP-9) for lung cancer brain metastasis. Methods　One hundred and sixteen patients with advanced lung cancer and suspected brain metastases treated at Yulin First Hospital from June 2019 to June 2023 were selected as the study objects, including 72 males and 44 females. They were (61.93±9.21) years old. With pathological examination as the gold standard for diagnosing brain metastasis, the patients were divided into a brain metastasis group and a lung cancer group. All the patients underwent DSC-PWI examination to obtain cerebral blood volume (CBV) and cerebral blood flow (CBF), and the perfusion parameters of the abnormal perfusion area and contralateral mirror area within the tumor were standardized to obtain mean local cerebral blood volume (rCBV) and mean local cerebral blood flow (rCBF). The DSC-PWI quantitative parameters and levels of α-HBDH and MMP-9 were compared between the two groups. The risk factors for lung cancer brain metastasis was analyzed. The diagnostic values of DSC-PWI quantitative parameters, α - HBDH, and MMP-9 for lung cancer brain metastasis were evaluated. t and χ² tests were used for the statistical analysis. Results　According to pathological diagnosis, 84 out of the 116 patients were diagnosed with brain metastases. The rCBV, rCBF, serum α-HBDH, and serum MMP-9 in the brain metastasis group and the lung cancer group were 2.54±0.72 and 0.97±0.31, 2.31±0.75 and 1.16 ± 0.41, (176.31±38.54) U/L and (141.09±35.16) U/L, and (114.35±26.98) ng/L and (98.51±17.04) ng/L, respectively, with statistical differences between the two groups (all P<0.05). rCBV (OR=3.691, 95%CI 1.630-8.357), rCBF (OR=3.647, 95%CI 1.611-8.258), α-HBDH (OR=4.104, 95%CI 1.812-9.292), and MMP-9 (OR=3.955, 95%CI 1.747-8.954) were the risk factors for brain metastasis in the patients (all P<0.05). The sensitivities of rCBV, rCBF, α-HBDH, and MMP-9 in the diagnosis of lung cancer brain metastasis were 0.82, 0.73, 0.71, 0.80, and 0.89, respectively; the specificities were 0.78, 0.77, 0.69, 0.59, and 0.91; the areas under the curves were 0.781, 0.725, 0.731, 0.739, and 0.885, respectively. Conclusion　rCBV, rCBF, α-HBDH, and MMP-9 are associated with lung cancer brain metastasis and can be used as auxiliary diagnostic tools for lung cancer brain metastasis, with good diagnostic efficacy.

Key words: Lung cancer, , Brain metastasis, , Dynamic susceptibility contrast-enhanced perfusion-weighted imaging, , Alpha hydroxybutyrate dehydrogenase, , Matrix metalloproteinase-9

田娟闫腾席俊峰王慧芳.

DSC-PWI定量参数联合血清α-HBDH和MMP-9对肺癌脑转移的诊断价值 [J]. 国际医药卫生导报, 2025, 31(14): 2424-2428.

Tian Juan, Yan Teng, Xi Junfeng, Wang Huifang.

Diagnostic value of DSC-PWI quantitative parameters combined with serum α-HBDH and MMP-9 for lung cancer brain metastasis [J]. International Medicine and Health Guidance News, 2025, 31(14): 2424-2428.

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