MRI联合血清KLF5、PIVKA-Ⅱ对肝脏局灶性结节增生的诊断价值

摘要/Abstract

摘要： 目的探究核磁共振成像(MRI)联合血清Kruppel样因子5(KLF5)、异常凝血酶原(PIVKA-Ⅱ)对肝脏局灶性结节增生的诊断价值。方法选取2020年3月—2023年3月在石家庄市第五医院治疗的146例确诊的肝脏结节增生患者为研究对象,以病理学检查为金标准,根据检查结果分为肝脏局灶性结节增生组(90例)和非肝脏局灶性结节增生组(56例)。采用酶联免疫吸附测定法(ELISA)测定血清KLF5水平,采用化学发光法检测血清PIVKA-Ⅱ水平;受试者工作特征(ROC)曲线分析血清KLF5、PIVKA-Ⅱ水平对肝脏局灶性结节增生的诊断价值;四格表法分析MRI联合血清KLF5、PIVKA-Ⅱ水平对肝脏局灶性结节增生的诊断价值。结果肝脏局灶性结节增生组饮酒史占比、血清KLF5、PIVKA-Ⅱ显著高于非肝脏局灶性结节增生组[分别为51(56.67%)比22(39.29%)、(4.15±1.25 )比(1.87±0.31) ng/mL、(26.43±5.33)比(19.24±4.64)mAu/mL,均P<0.05 ];血清KLF5、PIVKA-Ⅱ诊断肝脏局灶性结节增生的曲线下面积分别为0.912、0.871,敏感度分别为88.76%、84.27%,特异性分别为82.14%、83.93%,最佳截断值分别为2.84 ng/mL、21.22 mAu/mL;MRI检查结果与金标准具有一致性(Kappa值=0.426,P值<0.001);血清KLF5、PIVKA-Ⅱ检查结果与金标准具有一致性(Kappa值=0.430、0.438,P值<0.001);三者联合检查结果与金标准具有较高的一致性(Kappa值=0.709,P值<0.001);MRI联合血清KLF5、PIVKA-Ⅱ诊断肝脏局灶性结节增生的敏感度、准确度均显著高于MRI、血清KLF5、PIVKA-Ⅱ单独诊断(P<0.05)。结论肝脏局灶性结节增生患者血清KLF5、PIVKA-Ⅱ水平上调,且MRI联合血清KLF5、PIVKA-Ⅱ对疾病有更高的诊断价值。

关键词: 肝脏局灶性结节增生, 核磁共振成像, Kruppel样因子5, 异常凝血酶原

Abstract: Objective To explore the diagnostic value of magnetic resonance imaging (MRI) combined with serum Kruppel like factor 5 (KLF5) and abnormal prothrombin (PIVKA-II) in liver focal nodular hyperplasia.Methods From March 2020 to March 2023, 146 confirmed patients with liver nodular hyperplasia treated in our hospital were regarded as subjects. Based on pathological examination as the gold standard, they were grouped into two groups according to the examination results: the liver focal nodular hyperplasia group (90 cases) and the non-liver focal nodular hyperplasia group (56 cases). Enzyme linked immunosorbent assay (ELISA) was applied to measure serum KLF5 level. Chemiluminescence method was applied to detect serum PIVKA-II level. Receiver operating characteristic (ROC) curve was applied to analyze the diagnostic value of serum KLF5 and PIVKA-II levels for liver focal nodular hyperplasia. Four grid table method was applied to analyze the diagnostic value of MRI combined with serum KLF5 and PIVKA-II levels for liver focal nodular hyperplasia.Results The proportion of alcohol consumption [51 (56.67%) vs. 22 (39.29%)], serum KLF5 [(4.15±1.25) ng/mL vs. (1.87±0.31) ng/mL], and PIVKA-Ⅱ [(26.43±5.33) mAu/mL vs. (19.24±4.64) mAu/mL] levels in the liver focal nodular hyperplasia group were obviously higher than those in the non-liver focal nodular hyperplasia group (P<0.05). The area under the curve (AUC) of serum KLF5 and PIVKA-Ⅱ for diagnosing liver focal nodular hyperplasia was 0.912 and 0.871, respectively, with sensitivity of 88.76% and 84.27%, the specificity of 82.14% and 83.93%, and the optimal cut-off value of 2.84 ng/mL and 21.22 mAu/mL, respectively. The MRI examination results were consistent with the gold standard (Kappa value=0.426, P value < 0.001). The results of serum KLF5 and PIVKA-II tests were consistent with the gold standard (Kappa values = 0.430, 0.438, P values < 0.001). The joint examination results of the combination of MRI, serum KLF5 and PIVKA-II had high consistency with the gold standard (Kappa value=0.709, P value < 0.001). The sensitivity and accuracy of MRI combined with serum KLF5 and PIVKA-II in diagnosing liver focal nodular hyperplasia were obviously higher than those of the individual diagnosis of MRI, serum KLF5, PIVKA-II (P<0.05).Conclusion Serum KLF5 and PIVKA-II levels are up-regulated in patients with liver focal nodular hyperplasia, and MRI combined with serum KLF5 and PIVKA-II has higher diagnostic value for disease.

Key words: Liver focal nodular hyperplasia, Magnetic resonance imaging, Kruppel like factor 5, Abnormal prothrombin

杨明, 邢卫红, 李若旭, 董发发, 侯懿瑄. MRI联合血清KLF5、PIVKA-Ⅱ对肝脏局灶性结节增生的诊断价值[J]. 肝脏, 2025, 30(3): 347-351.

YANG Ming, XING Wei-hong, LI Ruo-xu, DONG Fa-fa, HOU Yi-xuan. Diagnostic value of MRI combined with serum KLF5 and PIVKA-Ⅱ in liver focal nodular hyperplasia[J]. Chinese Hepatolgy, 2025, 30(3): 347-351.

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