中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
19期
1472-1475
,共4页
贾中芝%黄渊全%冯耀良%蒋国民
賈中芝%黃淵全%馮耀良%蔣國民
가중지%황연전%풍요량%장국민
肝肿瘤%缺氧诱导因子1,α亚基%血管内皮生长因子类
肝腫瘤%缺氧誘導因子1,α亞基%血管內皮生長因子類
간종류%결양유도인자1,α아기%혈관내피생장인자류
Liver neoplasms%Hypoxia-inducible factor 1,alpha subunit%Vascular endothelial growth factors
目的 探讨原发性肝癌(HCC)经导管动脉化疗栓塞(TACE)术前后血清缺氧诱导因子-Iα(HIF-1α)及血管内皮生长因子(VEGF)与肿瘤组织CT灌注参数的相关性.方法 对2008年3月至2010年7月南京医科大学附属常州第二人民医院介入与血管外科22例HCC患者TACE术前1d,术后32～40 d行血清HIF-1α及VEGF检测及CT灌注成像(CTPI),得到血清HIF-1 0、VEGF、肿瘤组织肝动脉灌注量(HAP)、门静脉灌注量(PVP)及肝动脉灌注指数(HPI)等参数值,并进行统计学分析.结果 根据TACE术后32 ～40 d疗效分为:稳定组和肿瘤残存或复发组.术前两组血清HIF-1αt(μg/L)、VEGF(μg/L)及HAP[ml·min-1·(100 ml)-1]、PVP[ml· min-1·(100 mL)-1]、HPI差异均无统计学意义,而术后差异均有统计学意义[稳定组比复发组:124±60比258±113,144 ±94比354±137,0比33±11,0比21±12,0比61±10]；术后32～40 d:稳定组血清HIF-1α、VEGF较术前明显降低,血清VEGF差异有统计学意义(均P＜0.05),肿瘤组织未检测到HAP、PVP灌注信号；而肿瘤残存或复发组血清HIF-1α、VEGF较术前均增高,差异均有统计学意义(均P＜0.05),肿瘤组织HAP、HPI较术前明显降低,差异均有统计学意义(均P＜0.05),PVP无明显变化.术后32～40 d血清HIF-1α、VEGF与肿瘤组织HAP、HPI呈正相关.结论 血清HIF-lα、VEGF能够间接反映TACE术后肿瘤组织微血管生成情况；CTPI能直观和定量地反映TACE术后肿瘤组织的血流动力学变化.故联合应用血清HIF-Iα、VEGF及CTPI有助于TACE术后疗效的评价,对明确再次TACE治疗的时间及治疗方案的确定具有重要临床价值.
目的 探討原髮性肝癌(HCC)經導管動脈化療栓塞(TACE)術前後血清缺氧誘導因子-Iα(HIF-1α)及血管內皮生長因子(VEGF)與腫瘤組織CT灌註參數的相關性.方法 對2008年3月至2010年7月南京醫科大學附屬常州第二人民醫院介入與血管外科22例HCC患者TACE術前1d,術後32～40 d行血清HIF-1α及VEGF檢測及CT灌註成像(CTPI),得到血清HIF-1 0、VEGF、腫瘤組織肝動脈灌註量(HAP)、門靜脈灌註量(PVP)及肝動脈灌註指數(HPI)等參數值,併進行統計學分析.結果 根據TACE術後32 ～40 d療效分為:穩定組和腫瘤殘存或複髮組.術前兩組血清HIF-1αt(μg/L)、VEGF(μg/L)及HAP[ml·min-1·(100 ml)-1]、PVP[ml· min-1·(100 mL)-1]、HPI差異均無統計學意義,而術後差異均有統計學意義[穩定組比複髮組:124±60比258±113,144 ±94比354±137,0比33±11,0比21±12,0比61±10]；術後32～40 d:穩定組血清HIF-1α、VEGF較術前明顯降低,血清VEGF差異有統計學意義(均P＜0.05),腫瘤組織未檢測到HAP、PVP灌註信號；而腫瘤殘存或複髮組血清HIF-1α、VEGF較術前均增高,差異均有統計學意義(均P＜0.05),腫瘤組織HAP、HPI較術前明顯降低,差異均有統計學意義(均P＜0.05),PVP無明顯變化.術後32～40 d血清HIF-1α、VEGF與腫瘤組織HAP、HPI呈正相關.結論 血清HIF-lα、VEGF能夠間接反映TACE術後腫瘤組織微血管生成情況；CTPI能直觀和定量地反映TACE術後腫瘤組織的血流動力學變化.故聯閤應用血清HIF-Iα、VEGF及CTPI有助于TACE術後療效的評價,對明確再次TACE治療的時間及治療方案的確定具有重要臨床價值.
목적 탐토원발성간암(HCC)경도관동맥화료전새(TACE)술전후혈청결양유도인자-Iα(HIF-1α)급혈관내피생장인자(VEGF)여종류조직CT관주삼수적상관성.방법 대2008년3월지2010년7월남경의과대학부속상주제이인민의원개입여혈관외과22례HCC환자TACE술전1d,술후32～40 d행혈청HIF-1α급VEGF검측급CT관주성상(CTPI),득도혈청HIF-1 0、VEGF、종류조직간동맥관주량(HAP)、문정맥관주량(PVP)급간동맥관주지수(HPI)등삼수치,병진행통계학분석.결과 근거TACE술후32 ～40 d료효분위:은정조화종류잔존혹복발조.술전량조혈청HIF-1αt(μg/L)、VEGF(μg/L)급HAP[ml·min-1·(100 ml)-1]、PVP[ml· min-1·(100 mL)-1]、HPI차이균무통계학의의,이술후차이균유통계학의의[은정조비복발조:124±60비258±113,144 ±94비354±137,0비33±11,0비21±12,0비61±10]；술후32～40 d:은정조혈청HIF-1α、VEGF교술전명현강저,혈청VEGF차이유통계학의의(균P＜0.05),종류조직미검측도HAP、PVP관주신호；이종류잔존혹복발조혈청HIF-1α、VEGF교술전균증고,차이균유통계학의의(균P＜0.05),종류조직HAP、HPI교술전명현강저,차이균유통계학의의(균P＜0.05),PVP무명현변화.술후32～40 d혈청HIF-1α、VEGF여종류조직HAP、HPI정정상관.결론 혈청HIF-lα、VEGF능구간접반영TACE술후종류조직미혈관생성정황；CTPI능직관화정량지반영TACE술후종류조직적혈류동역학변화.고연합응용혈청HIF-Iα、VEGF급CTPI유조우TACE술후료효적평개,대명학재차TACE치료적시간급치료방안적학정구유중요림상개치.
Objective To explore the correlations between the serum levels of hypoxia inducible factor-1 o (HIF-1 α),vascular endothelial growth factor (VEGF) and computed tomography (CT) perfusion parameters at pre-and post-transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC).Methods A total of 22 PHC patients were recruited.Their serum levels of HIF-1α and VEGF were measured and CT perfusion imaging (CTPI) was performed at Day 1 pre-and Days 32-40 post-TACE to compare and analyze the relevance of the changes of serum levels of HIF-1α,VEGF,tumor's hepatic artery perfusion (HAP),portal vein perfusion (PVP) and hepatic artery perfusion index (HPI) at pre-and post-TACE.Results They were divided into stable and tumor residual/recurrent groups according to the efficacy of TACE.No significant differences existed between two groups with respects to serum levels of HIF-lα,VEGF,tumor's HAP,PVP and HPI pre-TACE.The serum levels of HIF-lα and VEGF decreased in stable group and there was significant difference in serum level of VEGF at Days 32-40post-TACE (P ＜ 0.05).There was no perfusion signal of HAP or PVP in tumor tissue.The serum levels of HIF-1 α and VEGF were significantly higher while HAP and HPI were significantly lower than that pre-TACE in tumor residual/recurrent group and had statistical significance (P ＜ 0.05),but PVP had no change.Positive correlations existed between sermn levels of HIF-1α,VEGF and tumor's HAP,HPI at 32-40 days post-TACE.Conclusion Serum levels of HIF-1 α and VEGF may indirectly reflect the status of neovascularization and CTPI acts as the intuitive and quantitative responses of hemodynamic changes at postTACE.Positive correlations exist between serum levels of HIF-lα,VEGF,HAP and HPI.In short,a combination of serum levels of HIF-1 α,VEGF and CTPI contributes to the efficacy evaluation of TACE and has great reference significance of determining timing of a second therapy.
