| 罗露露,马青松.基于能谱CT测定CT值、曲线斜率与脊柱转移瘤病人血管新生及预后的关系.骨科,2024,15(4): 314-319. |
| 基于能谱CT测定CT值、曲线斜率与脊柱转移瘤病人血管新生及预后的关系 |
| Relationship between CT Value, Curve Slope Measured by Spectral CT and Angiogenesis and Prognosis in Patients with Spinal Metastases |
| 投稿时间：2024-04-08 |
| DOI：10.3969/j.issn.1674-8573.2024.04.005 |
| 中文关键词: 脊柱转移瘤 能谱CT CT值 能谱曲线斜率 新血管生成 预后 |
| 英文关键词: Spinal metastasis Energy spectrum CT CT value Slope of energy spectrum curve Neoangiogenesis Prognosis |
| 基金项目:资阳市医学科学课题项目（KY2023054） |
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| 中文摘要: |
| 目的 探讨能谱CT测定CT值、能谱曲线斜率与脊柱转移瘤（SM）病人血管新生标志物及预后的关系。方法 选取2021年5月至2023年5月我院85例SM病人作为研究组，另选同期85例恶性肿瘤无骨转移病人作为对照组，两组均行能谱CT测定，比较两组一般资料、能谱CT值（40~90 keV）及曲线斜率，并比较研究组SM肿瘤组织和瘤旁正常组织血管新生标志物[血管内皮生长因子（VEGF）、金属基质蛋白酶-9（MMP-9）]表达情况，分析能谱CT参数与SM肿瘤组织血管新生标志物的相关性。研究组随访1年，统计预后情况，比较死亡与存活病人临床资料，分析SM病人预后为死亡的影响因素，并分析能谱CT参数预测SM病人死亡的价值。结果 研究组40~90 keV对应的CT值、曲线斜率均显著低于对照组（P＜0.05）；研究组肿瘤组织VEGF、MMP-9阳性表达率（76.47%、83.53%）高于瘤旁正常组织（44.71%、17.65%）（P＜0.05）；研究组CT值（40~90 keV）、曲线斜率与SM肿瘤组织VEGF、MMP-9阳性表达呈负相关（P＜0.05）；研究组完成随访的病人中，死亡病人确诊至转移时间短于存活病人，脏器转移占比、脊柱外骨转移占比高于存活病人，术后局部放疗占比、40 keV对应CT值、50 keV对应CT值、曲线斜率低于存活病人（P＜0.05）；确诊至转移时间、脏器转移、脊柱外骨转移、术后局部放疗、40 keV对应CT值、曲线斜率均为SM病人预后为死亡的独立影响因素（P＜0.05）；40 keV对应CT值、曲线斜率单独预测预后为死亡的AUC分别为0.805、0.798，联合预测的AUC为0.931，大于二者单独预测的AUC（P＜0.05）。结论 能谱CT测定CT值（40~90 keV）、曲线斜率与SM肿瘤组织血管新生标志物密切相关，其中40 keV对应CT值、曲线斜率均为SM病人预后为死亡的独立影响因素，二者联合可为临床预测预后提供可靠参考依据。 |
| 英文摘要: |
| Objective To investigate the relationship between CT value, spectral curve slope measured by spectral CT and angiogenesis markers and prognosis in patients with spinal metastasis (SM). Methods A total of 85 patients with SM in our hospital from May 2021 to May 2023 were selected as the study group, and 85 patients with malignant tumor without bone metastasis were selected as the control group during the same period. Energy spectrum CT was performed in both groups, and the basic data, CT value (40-90 keV), curve slope of the two groups were compared. The expression of angiogenesis markers such as vascular endothelial growth factor (VEGF), metallomatrix proteinase-9 (MMP-9) in SM tumor tissues and adjacent normal tissues of the study group was compared, and the correlation between energy spectrum CT parameters and angiogenesis markers in SM tumor tissues was analyzed. The study group was followed up for 1 year, the prognosis was statistically analyzed, the clinical data of death and survival patients were compared, the prognosis of SM patients was analyzed as the influencing factor of death, and the value of energy spectrum CT parameters in predicting the prognosis of SM patients was analyzed. Results The CT value (40-90 keV) and curve slope of the study group were lower than those of the control group (P＜0.05). The positive expression rates of VEGF and MMP-9 in tumor tissues (76.47% and 83.53%) were higher than those in adjacent normal tissues (44.71% and 17.65%) (P＜0.05). In the study group, CT values (40-90 keV) and curve slope were negatively correlated with the positive expression of VEGF and MMP-9 in SM tumor tissues (P＜0.05). Among the patients who completed follow-up in the study group, the time from diagnosis to metastasis of the deceased patients was shorter than that of the surviving patients, the proportion of internal metastasis and extra-spinal bone metastasis was higher than that of the surviving patients, and the proportion of postoperative local radiotherapy, CT value of 40 keV, CT value of 50 keV and curve slope was lower than that of the surviving patients (P＜0.05). The time from diagnosis to metastasis, visceral metastasis, extra-spinal bone metastasis, postoperative local radiotherapy, CT value of 40 keV and curve slope were all independent influencing factors of prognosis and death in SM patients (P＜0.05). The AUC of 40 keV and curve slope alone predicting the prognosis of death was 0.805 and 0.798, respectively, and the AUC of combined prediction was 0.931, which was greater than the AUC predicted by the two alone (P＜0.05). Conclusion CT value (40-90 keV) and curve slope measured by energy spectrum CT are closely related to the angiogenesis markers of SM tumor tissue, in which CT value of 40 keV and curve slope are independent influencing factors of prognosis and death in SM patients, and the combination of the two can provide a reliable reference for clinical prognosis prediction. |
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