CAJ | 학술논문

目的：通过磁共振成像（MRI）和MRI定量指标来研究星形细胞瘤弥散成像、瘤周水肿与肿瘤缺氧诱导因子-1α（HIF-1α）表达水平的相关性，以及星形细胞瘤在缺氧环境下的浸润、生长、增殖能力及恶性度，更好地指导临床治疗及预后评估。方法选取经手术病理证实的33例星形细胞瘤患者，术前均进行磁共振弥散加权成像（DWI）检查，并计算肿瘤实质部分的ADC值；计算MRI水肿指数（EI），采用免疫组化法检测HIF-1α的表达情况。结果低级别星形细胞瘤（WHOⅠ～Ⅱ级）的平均ADC值高于高级别星形细胞瘤（WHOⅢ～Ⅳ级），低级别星形细胞瘤平均EI值低于高级别星形细胞瘤，高、低级别星形细胞瘤中HIF-1α均有表达，且星形细胞瘤的HIF-1α表达水平随着星形细胞瘤临床病理程度增高而加强，低级别星形细胞瘤内部平均HIF-1α指数低于高级别星形细胞瘤；肿瘤区ADC值与HIF-1α呈显著负相关，肿瘤区ADC值和EI值呈负相关，HIF-1α和EI值无明显相关性。结论核磁共振定量参数ADC值、EI值与常规MRI联合应用及HIF-1α的表达可显著提高星形细胞瘤术前分级的准确性，进而指导治疗方案的选择；MRI虽然能很好地间接反应星形细胞瘤的分子生物学行径，但瘤周水肿不能用单一理论解释。
목적：통과자공진성상（MRI）화MRI정량지표래연구성형세포류미산성상、류주수종여종류결양유도인자-1α（HIF-1α）표체수평적상관성，이급성형세포류재결양배경하적침윤、생장、증식능력급악성도，경호지지도림상치료급예후평고。방법선취경수술병리증실적33례성형세포류환자，술전균진행자공진미산가권성상（DWI）검사，병계산종류실질부분적ADC치；계산MRI수종지수（EI），채용면역조화법검측HIF-1α적표체정황。결과저급별성형세포류（WHOⅠ～Ⅱ급）적평균ADC치고우고급별성형세포류（WHOⅢ～Ⅳ급），저급별성형세포류평균EI치저우고급별성형세포류，고、저급별성형세포류중HIF-1α균유표체，차성형세포류적HIF-1α표체수평수착성형세포류림상병리정도증고이가강，저급별성형세포류내부평균HIF-1α지수저우고급별성형세포류；종류구ADC치여HIF-1α정현저부상관，종류구ADC치화EI치정부상관，HIF-1α화EI치무명현상관성。결론핵자공진정량삼수ADC치、EI치여상규MRI연합응용급HIF-1α적표체가현저제고성형세포류술전분급적준학성，진이지도치료방안적선택；MRI수연능흔호지간접반응성형세포류적분자생물학행경，단류주수종불능용단일이론해석。
Objective To explore the value of the relationship among different MRI quantitative parameters,peritumoral edema and the expression of hypoxia inducible factor-1 alpha(HIF-1α)in the preoperative diagnosis of cerebral astrocytoma. The ability of growth ,invasion and generation in the hypoxia condition will be better expressed by the diagnosis of MRI level ,which will be very helpful for evaluating pathological grade,preferably guiding clinical theraphy and the evaluating prognosis in cerebral astrocytoma. Methods Thirty-three cases of astrocytoma proved by operation and pathology were sutdied by DWI;The volume of tumor and the extent of peritumorous brain edema(PTBE)were determined on MRI. Edema index(EI)was used to evaluate the extent of PTBE;HIF-1αon the specimens of the tumors was stained with immunohistochemical method . Results The average ADC value of low grade(gradeⅠ-Ⅱ) astrocytoma is higher than that of high grade(gradeⅢ-Ⅳ)astrocytoma. There were significantly different between the low grade astrocytoma and high grade astrocytoma. The average EI value of low grade(grade Ⅰ-Ⅱ)astrocytoma is lower than that of high grade(grade Ⅲ-Ⅳ)astrocytoma. The expression level of HIF-1αin cerebral astrocytoma is:low grade astrocytoma:(20.08±10.01)%;high grade astrocytoma:(47.91±19.03)%. They were significantly different between the two group. There was no obvious significant correlation existed between the value of HIF-1αLIs and EI. ADC and HIF-1αLIs,EI showed significantly negative correlation . Conclusion The MRI quantitative parameters like the value of ADC,EI associating with conventional MRI and the expression of HIF-1αcan significantly raise the accuracy of preoperative evaluation of cerebral astrocytoma and choose the effective therapy plan . Cerebral astrocytoma with rich vascular components are often accompanied by peritumoral edema but it can’t be explained by only one theory .