CAJ | 학술논문

目的观察放射外科治疗后星形胶质细胞瘤的病理、超微结构及肿瘤相关因子Ki-67、血管内皮生长因子(VEGF)、微血管密度(MVD)的变化。方法收集四川省人民医院神经外科自1995年11月至2008年7月间行放射外科治疗后手术切除的脑胶质瘤标本25例（治疗组），同期未接受任何放、化疗原发性脑胶质瘤标本25例作为对照组,2组均由术者留取8例戊二醛固定的电镜标本，观察标本常规病理(HE染色)及肿瘤中心、边缘及瘤周2cm范围内水肿组织超微结构的改变;采用免疫组化染色检测标本Ki-67、VEGF、MVD的表达。结果治疗组星形细胞瘤坏死程度与肿瘤级别呈正相关(r=0.649,P=0.001)；电镜下放疗组肿瘤细胞的细胞器、微血管、血脑屏障分别在肿瘤的中心、肿瘤边缘、瘤周水肿脑组织发生不同程度的变性坏死，而对照组胶质瘤细胞器完整;免疫组化染色结果显示2组标本Ki-67阳性细胞百分率、VEGF蛋白表达和MVD与肿瘤分级均呈正相关关系(P＜0.05)，与对照组同级别胶质瘤比较，治疗组Ki-67阳性细胞百分率、MVD较低，差异均有统计学意义(P＜0.05)。结论接受放射外科治疗后肿瘤细胞出现不同程度的变性、坏死、凋亡、微血管血脑屏障破坏，为胶质瘤个体化综合性治疗提供重要佐证。
목적관찰방사외과치료후성형효질세포류적병리、초미결구급종류상관인자Ki-67、혈관내피생장인자(VEGF)、미혈관밀도(MVD)적변화。 방법수집사천성인민의원신경외과자1995년11월지2008년7월간행방사외과치료후수술절제적뇌효질류표본25례（치료조），동기미접수임하방、화료원발성뇌효질류표본25례작위대조조,2조균유술자류취8례무이철고정적전경표본，관찰표본상규병리(HE염색)급종류중심、변연급류주2cm범위내수종조직초미결구적개변;채용면역조화염색검측표본Ki-67、VEGF、MVD적표체。 결과 치료조성형세포류배사정도여종류급별정정상관(r=0.649,P=0.001)；전경하방료조종류세포적세포기、미혈관、혈뇌병장분별재종류적중심、종류변연、류주수종뇌조직발생불동정도적변성배사，이대조조효질류세포기완정;면역조화염색결과현시2조표본Ki-67양성세포백분솔、VEGF단백표체화MVD여종류분급균정정상관관계(P＜0.05)，여대조조동급별효질류비교，치료조Ki-67양성세포백분솔、MVD교저，차이균유통계학의의(P＜0.05)。 결론접수방사외과치료후종류세포출현불동정도적변성、배사、조망、미혈관혈뇌병장파배，위효질류개체화종합성치료제공중요좌증。
Objective To study the histopathological changes and ultrastructure features of human gliomas after receiving stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT), and observe the changes of tumor-associated factor Ki-67 level, endothelial growth factor (VEGF) level and microvessel density (MVD).Methods A comparative, retrospective study of pathological and immunohistochemical changes of 25 gliorna specimens without radiotherapy (controls) and 25 patients with glioma received with SRS and SRT (treatment group), admitted to our hospital from November 1995to July 2008, were carried out. Eight specimens from both groups, fixed with glutaraldehyde, were chosen for electron microscope observation; the ultrastructure changes in the tumor center, tumor margin and peripheral edema brain tissues in each specimen were observed. Immunohistochemical staining was employed to detect the expressions of Ki-67 and VEGF, and the MVD. And these data were statistically analyzed. Results The square and extent of tumor necrosis and liquation were positively significantly correlated with the tumor grade (r=0.649, P=0.001). Electron microscope indicated that the organdles,capillaries and blood-brain barrier in the tumor center, tumor margin and peritumoral edema cortex of the treatment group occurred different degrees of brain tissue degeneration and necrosis; while these were without damage in the controls. Immunohistochemistry showed that the protein expression of VEGF, the Ki-67 positive cells, and the MVD in the control group and treatment group were positively correlated with the glioma grade (P＜0.05). Of the glioma with the same grade, the Ki-67 protein expression and MVD in the treatment group were significantly lower than those in the control group (P＜0.05).Conclusion SRS and SRT may lead tumor cells to different degrees of degeneration, necrosis, and apoptosis, as well as the three-tier structure damage of capillaries in the blood-brain barrier, which provides a laboratory and theoretical foundation to take individualized comprehensive treatment of different gliomas.