CAJ | 학술논문

目的：建立兔肝转移瘤（liver metastasis，LM）模型，通过免疫组织化学及 CT灌注扫描分析兔 LM的血液供应来源。方法将 VX2瘤株种植于新西兰大白兔（35只）脾脏，CT 扫描确认 LM 形成后，行灌注扫描分析灌注参数，分离荷瘤兔 LM 行 CD34、细胞间黏附分子1（intercellular cell adhesion moleculer-1，ICAM-1）、α平脊肌肌动蛋白（α-smooth muscle actin，α-SMA）免疫组织化学染色。结果兔 LM（315．76±24．78）μm 时瘤内表达 ICAM-1、CD34，α-SMA 未见表达，瘤内阳性 ICAM-1与邻近肝窦内阳性 ICAM-1相连；LM（632．58±35．46）μm 时瘤内表达 ICAM-1、CD34及少量α-SMA 表达，瘤内阳性 ICAM-1与邻近肝窦内阳性 ICAM-1相连；LM（1056．32±124．67）μm 时瘤内表达 CD34、α-SMA 及少量 ICAM-1表达；LM（2183．15±167．32）μm 和 LM（5326．00±172．51）μm 时瘤内表达 CD34、α-SMA，ICAM-1染色消失或仅有少量的染色出现在瘤旁或与瘤灶相邻的正常肝窦中；在1.0 cm 以上时坏死区周围瘤组织表达 CD34、α-SMA，ICAM-1染色同前。兔 LM 的 CT 灌注扫描表现为环形强化，环形强化区的组织血流量、组织血容量、肝动脉供血分数、肝动脉灌注量、肝动脉灌注指数明显大于瘤周正常肝组织，门静脉灌注量、门静脉灌注指数明显小于瘤周正常肝组织，差异有统计学意义（P ＜0．01）。结论兔 LM 的早期阶段由门静脉供血，肝动脉不参与供血，随着 LM 的增大，肝动脉供血逐渐增加，门静脉供血逐渐减少，到 LM （2183．15±167．32）μm 以上时仅为肝动脉供血，门静脉不参与供血。
목적：건립토간전이류（liver metastasis，LM）모형，통과면역조직화학급 CT관주소묘분석토 LM적혈액공응래원。방법장 VX2류주충식우신서란대백토（35지）비장，CT 소묘학인 LM 형성후，행관주소묘분석관주삼수，분리하류토 LM 행 CD34、세포간점부분자1（intercellular cell adhesion moleculer-1，ICAM-1）、α평척기기동단백（α-smooth muscle actin，α-SMA）면역조직화학염색。결과토 LM（315．76±24．78）μm 시류내표체 ICAM-1、CD34，α-SMA 미견표체，류내양성 ICAM-1여린근간두내양성 ICAM-1상련；LM（632．58±35．46）μm 시류내표체 ICAM-1、CD34급소량α-SMA 표체，류내양성 ICAM-1여 린 근 간 두 내 양 성 ICAM-1상 련；LM（1056．32±124．67）μm 시류내표체 CD34、α-SMA 급소량 ICAM-1표체；LM（2183．15±167．32）μm 화 LM（5326．00±172．51）μm 시류내표체 CD34、α-SMA，ICAM-1염색소실혹부유소량적염색출현재류방혹여류조상린적정상간두중；재1.0 cm 이상시배사구주위류조직표체 CD34、α-SMA，ICAM-1염색동전。토 LM 적 CT 관주소묘표현위배형강화，배형강화구적조직혈류량、조직혈용량、간동맥공혈분수、간동맥관주량、간동맥관주지수명현대우류주정상간조직，문정맥관주량、문정맥관주지수명현소우류주정상간조직，차이유통계학의의（P ＜0．01）。결론토 LM 적조기계단유문정맥공혈，간동맥불삼여공혈，수착 LM 적증대，간동맥공혈축점증가，문정맥공혈축점감소，도 LM （2183．15±167．32）μm 이상시부위간동맥공혈，문정맥불삼여공혈。
Objective To explore the blood supply of rabbit liver metastasis(LM)based on its model by using CT perfusion and immunohistochemical method.Methods VX2 tumor strains were injected in the spleen of 35 New Zealand white rabbits.The LM was confirmed by using CT scan,and then the CT perfusion was performed.The rabbit LM was separated.The immunohistochemical staining was used to observe the expressions of CD34,intercellular cell adhesion moleculer-1(ICAM-1)and α-smooth muscle actin(α-SMA).Results When the average size of LM neoplasm reached approximately to(315.76±24.78)μm,no expressions of ICAM-1, CD34 andα-SMA could be observed,and the ICAM-1 positive cells in the tumor were connected with the normal sinusoidal.CD34 and ICAM-1 positive cells and someα-SMA positive cells could be seen in the size of LM(632.58± 35.46)μm neoplasm,and the ICAM-1 positive cells in the tumor were connected with the normal sinusoidal.The CD34 and α-SMA positively expressed in the size of LM(1 056.32± 124.67)μm neoplasm,and the ICAM-1 positive cells were further reduced;only CD34 and α-SMA positive cells expressed in the average size of LM(2 183.15± 167.32)and LM(5 326.00± 172.51)μm neoplasms,ICAM-1 staining disappeared or only a few ICAM-1 positive cells could be found around the sinusoidal tumor or normal sinusoidal;the size of 1.0 cm metastases expressed the CD34,α-SMA and ICAM-1,and the staining was similar to the previous stage.LM showed ring staining.CT perfusion of LM of hepatic arterial fraction,hepatic arterial perfusion,hepatic arterial index were greater than the perlesion liver tissue,while portal vein perfusion and portal venous perfusion index were less than the perlesion liver tissue. Conclusion The early stage of rabbit LM was supplied by portal vein blood,with the increase of LM,the hepatic artery increased gradually,the portal vein blood supply decreased gradually.When LM developed to a certain stage,only the hepatic artery,portal vein does not participate in the blood supply.