Value of MR DWI combined with serum ApoA-1 level in predicting the curative effect of chemoradiotherapy on NSCLC patients
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摘要:
目的探究磁共振弥散加权成像（MR DWI）结合血清载脂蛋白A-1（ApoA-1）水平在预测非小细胞肺癌（NSCLC）患者放化疗疗效的价值。 方法选取2019年12月~2020年12月收治的120例NSCLC放化疗患者作为研究对象，患者治疗前后均行DWI检查以及血清ApoA-1水平测定，比较治疗前后DWI指标、ApoA-1水平，分析DWI指标与ApoA-1水平相关性；评估患者疗效，分析治疗前后DWI影像学表现，比较不同疗效治疗2个周期患者DWI指标、血清ApoA-1水平，分析DWI指标、血清ApoA-1水平对于患者疗效预测价值。 结果患者治疗后ADC值、ApoA-1水平较治疗前上升（P < 0.05）；随着治疗周期增加，ADC值、ApoA-1水平逐渐上升，差异有统计学意义（P < 0.05）；AFC值与ApoA-1水平显示为正相关关系（r=0.633，P < 0.05）；有效组患者ADC值、ApoA-1水平高于无效组（P < 0.05）；ROC曲线显示ADC值、ApoA-1用于预测患者疗效的AUC值分别为0.587、0.786，两指标联合AUC值为0.899。 结论NSCLC患者应用MR DWI结合血清ApoA-1水平可以有效提高对于患者放化疗疗效预测价值，有一定临床应用价值。 Abstract:ObjectiveTo explore the value of magnetic resonance diffusion weighted imaging(MR DWI)combined with level ofserum apolipoprotein A-1(ApoA-1)in predicting the curative effect of chemoradiotherapy on patients with non-small celllung cancer(NSCLC). MethodsA total of 120 NSCLC patients who underwent chemoradiotherapy and admitted fromDecember 2019 to December 2020 were enrolled.All patients underwent DWI examination and were tested for serum ApoA-1before and after treatment.DWI indexes and ApoA-1 level before and after treatment were compared.The correlation betweenDWI indexes and ApoA-1 level were analyzed.The curative effect on patients was evaluated.DWI imaging findings beforeand after treatment were analyzed.DWI indexes and level of serum ApoA-1 were compared among patients with differentcurative effect after 2 courses.Predictive value DWI indexes and serum ApoA-1 for curative effects were analyzed. ResultsAfter treatment, ADC and ApoA-1 level were significantly increased(P < 0.05).As the increase of treatment cycle, ADC valueand ApoA-1 level were gradually increased, and the differences were significant(P < 0.05).AFC value was positively correlatedwith ApoA-1(r=0.633, P < 0.05).ADC value and ApoA-1 level in effective group were significantly higher than those inineffective group(P < 0.05).ROC curves showed that AUC values of ADC value, ApoA-1 and their combination for predictingcurative effect were 0.587, 0.786 and 0.899, respectively. ConclusionThe application of MR DWI combined with level of serumApoA-1 can effectively improve the predictive value for curative effect of chemoradiotherapy on NSCLC patients. -
图 1 DWI影像学表现
A~C: 治疗前MRI影像表现，A为增强扫，B为DWI扫描，C为ADC图；D~F: 治疗1个周期MRI影像表现，D为增强扫，E为DWI扫描，F为ADC图；G~I: 治疗2个周期MRI影像表现，G为增强扫，H为DWI扫描，I为ADC图.
Figure 1. DWI imaging findings.
图 2 DWI指标、ApoA-1水平用于预测患者疗效价值分析ROC曲线
Figure 2. ROC curves of DWI indexes and ApoA-1 level predicting curative effect.
表 1 治疗前后DWI指标、ApoA-1水平比较
Table 1. Comparison of DWI indexes and ApoA-1 level before and after treatment (Mean±SD)
指标 治疗前 治疗1个周期 治疗2个周期 F P ADC值（×10-3 mm2/s） 1.18±0.24 1.49±0.31a 1.59±0.22ab 81.405 < 0.001 ApoA-1（g/L） 0.94±0.16 1.22±0.24a 1.43±0.34ab 109.437 < 0.001 aP < 0.05 vs治疗前；bP < 0.05 vs治疗1个周期. 
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表 2 不同疗效患者治疗后2周DWI指标、血清ApoA-1水平比较
Table 2. Comparison of DWI indexes and level of serum ApoA-1 among patients with different curative effect at 2 weeks after treatment (Mean±SD)
组别 ADC值（×10-3 mm2/s） ApoA-1（g/L） 有效组（n=32） 1.42±0.39 1.23±0.34 无效组（n=88） 1.09±0.43 0.83±0.37 t 3.807 5.347 P < 0.001 < 0.001
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表 3 DWI指标、ApoA-1水平用于预测患者疗效价值分析
Table 3. Predictive value of DWI indexes and ApoA-1 level for curative effect
指标 截断值 AUC 敏感度（%） 特异性（%） 95%CI P ADC值 1.24×10-3 mm2/s 0.587 43.8 83.0 0.466~0.709 0.014 ApoA-1 1.06 g/L 0.786 68.8 79.5 0.701~0.872 < 0.001 两指标联合 - 0.899 96.9 69.3 0.838~0.960 < 0.001
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