作者：张翠霞，刘宗杰，房勤茂，邓荷萍，隋鑫

单位：河北医科大学附属第三医院 超声诊断科，河北 石家庄 050000

Authors: Zhang Cuixia, Liu Zongjie, Fang Qinmao, Deng Heping, Sui Xin

Unit:  Department of Ultrasound Diagnosis, the Third Affiliated Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China

摘要：

目的  观察肝脏超声血流参数联合血清微小RNA-1203 （microRNA-1203，miR-1203）对乙型肝炎病毒（hepatitis B virus, HBV）相关性肝癌患者肝动脉化疗栓塞术（transcatheter arterial chemoembolization, TACE）疗效的预测价值。方法  选取河北医科大学附属第三医院2019年8月至2022年8月收治的113例HBV相关性肝癌患者作为研究对象，研究方法为前瞻性研究，于治疗前收集患者基线资料，行肝脏超声检查，记录血流参数，检测患者血清miR-1203水平，实施TACE治疗，评估疗效，根据疗效评估结果，将完全缓解+部分缓解+稳定患者纳入缓解组，将进展患者纳入未缓解组。采用多因素Logistic回归分析检验超声血流参数、血清miR-1203与HBV相关性肝癌患者TACE疗效的关系，并绘制受试者操作特征曲线（receiver operating characteristic curve，ROC曲线），分析超声血流参数联合血清miR-1203对HBV相关性肝癌患者TACE疗效的预测效能。结果  113例HBV相关性肝癌患者中，有85例缓解，纳入缓解组，有28例未缓解，纳入未缓解组。初步比较未缓解组与缓解组的基线资料、超声血流参数及miR-1203水平后，经多因素Logistic回归分析结果显示，Child-Pugh分级B级，病灶最大直径长，天冬氨酸转氨酶（aspartate transaminase，AST）、丙氨酸转氨酶（alanine transaminase，ALT）、肝脏阻力指数（resistance index，RI）、肝脏搏动指数（pulse index，PI）、miR-1203相对表达量高水平是TACE治疗后未缓解的危险因素（P＜0.05）；肝脏最大血流速度（peak systolic velocity，PSV）高是TACE治疗后未缓解的保护因素（P＜0.05）。绘制ROC曲线结果显示PI、RI、PSV、超声血流参数联合、血清miR-1203单项及四项指标联合预测HBV相关性肝癌患者TACE疗效的曲线下面积分别为0.771、0.764、0.722、0.855、0.753、0.892，均＞0.70，均有一定的预测价值。结论  HBV相关性肝癌患者行TACE治疗后未缓解与多种因素有关，其中超声血流参数、血清miR-1203可作为预测疗效的有效手段。

关键词： 肝癌；乙型肝炎病毒；肝动脉化疗栓塞术；阻力指数；搏动指数；最大血流速度；微小RNA-1203；疗效

Abstract：

Objective  To observe the predictive value of liver ultrasound blood flow parameters combined with serum microRNA-1203 (miR-1203) for the efficacy of transcatheter arterial chemoembolization (TACE) in patients with hepatitis B virus (HBV) related liver cancer. Method  113 patients with HBV related liver cancer treated in the Third Affiliated Hospital of Hebei Medical University from August 2019 to August 2022 were selected as the study subjects. The study method was prospective study, baseline data of patients were collected before treatment, liver ultrasound was performed, the blood flow parameters were recorded, serum miR-1203 levels of patients were detected, TACE was performed and its efficacy was evaluated. According to the evaluation results of efficacy, patients with complete remission + partial remission + stable were included in the remission group, while patients with progression were included in the non remission group. The relationship between ultrasound blood flow parameters, serum miR-1203 and efficacy of TACE in patients with HBV related liver cancer was examined by multivariate Logistic regression analysis, and the predictive effect of ultrasound blood flow parameters combined with serum miR -1203 on the efficacy of TACE in patients with HBV related liver cancer was analyzed by the receiver operating characteristic curve (ROC curve). Result  Among 113 patients with HBV related liver cancer, 85 cases had remission, included in the remission group, and 28 cases did not have remission, included in the non remission group. After preliminary comparing the baseline data, ultrasound blood flow parameters and miR-1203 levels between the non remission group and the remission group, multivariate Logistic regression analysis showed that Child-Pugh grade B, the maximum diameter of the lesion, high levels of relative expression of aspartate transaminase (AST), alanine transaminase (ALT), resistance index (RI), pulse index (PI) and miR-1203 were the risk factors for non remission after TACE (P<0.05); high peak systolic velocity (PSV) was a protective factor for non remission after TACE (P<0.05). The ROC curve showed that the area under the curve of PI, RI, PSV, combined ultrasound blood flow parameters, serum miR-1203 single and 4 combined indicators for predicting the efficacy of TACE in patients with HBV related liver cancer were 0.745,0.753,0.736,0.829,0.770 and 0.878, respectively, all>0.70, and all had certain predictive value. Conclusion  The rate of non remission in patients with HBV related liver cancer after TACE treatment is related to many factors, among them, ultrasound blood flow parameters and serummiR-1203 can be used as effective methods in predicting the efficacy.

Key Words: Liver cancer; Hepatitis B virus; Transcatheter arterial chemoembolization; Resistance index; Pulsatility index; Maximum blood flow velocity; MicroRNA-1203; Efficacy