磁共振波普成像及P53的表达在神经上皮性肿瘤诊断与治疗中的应用研究

发布时间：2018-05-24 03:27

本文选题：神经上皮性肿瘤 + 胶质瘤　；参考：《大理学院》2014年硕士论文

【摘要】：目的：研究磁共振波普成像(Magnetic Resonance Spectroscopy Imaging, MRSI)中的常见代谢物的值的变化规律，P53蛋白表达程度与胶质瘤的病理分级的关系，探讨临床实际工作中是否能利用MRSI代谢物值辅助中枢神经上皮性肿瘤（以下简称胶质瘤）诊断分级，治疗前确定手术或放疗的边界，利用P53蛋白的表达程度协助增加病理诊断准确性。方法：选取32例术前经做常规磁共振（Magnetic Resonance，MR）及磁共振波普（Magnetic Resonance Spectroscopy，MRS）扫描，且术后病理检查确诊为胶质瘤的患者为研究对象。MRS检查时，分别测量肿瘤实质部、瘤周水肿部及对侧大脑正常白质的代谢物值，，包括胆碱(CHO), N-乙酰天门冬氨酸(NAA),肌酐(CR),记录CHO/NAA，NAA/CR，CHO/CR值；术后肿瘤切除标本行常规病理检查及P53抗原的免疫组织化学检查，记录P53表达值；分析各部分各个记录值与胶质瘤部位，病理分级之间的相关性。结果： 1.胶质瘤不同部位MRS代谢物比值变化特点 CHO/NAA，CHO/CR，NAA/CR值，在肿瘤实质部，瘤周水肿部以及对侧正常脑组织中比值均不同，将比值结果两两比较，P0.05，有统计学意义，肿瘤实质部的CHO/NAA，CHO/CR大于瘤周水肿部与对侧正常脑组织，肿瘤实质部的NAA/CR小于瘤周水肿部与对侧正常脑组织。 2.不同病理级别胶质瘤MRS代谢物比值变化特点 CHO/NAA，CHO/CR值在高级别组胶质瘤（WHOIII-IV级）中明显大于低级别组胶质瘤（WHOI-II级），P0.05，有统计学意义；NAA/CR在高级别组胶质瘤（WHOIII-IV级）中明显小于低级别组胶质瘤（WHOI-II级），P0.05，有统计学意义。 3.P53在不同级别胶质瘤中的表达。 32例胶质瘤患者肿瘤中的P53蛋白表达与病理分级呈正相关（P0.05），呈线性关系，可认为病理级别越高，P53表达水平上升。结论： 1.胶质瘤肿瘤实质部，瘤周水肿部，对侧正常脑组织MRS代谢物比值是不同的，实质部与水肿部代谢物比值不同，水肿部与正常脑组织代谢物比值亦不同，临床实际工作中，可借助MRS用来辅助判断肿瘤侵犯脑组织的范围，从而为手术治疗前确定手术的边界提供参考依据。 2. MRS扫描的代谢物比值与胶质瘤的病理分级存在相关性，可以用来帮助判断胶质瘤的恶性程度，说明MRS对胶质瘤的临床诊断分级有一定帮助。 3.P53蛋白的表达能够在一定程度上反应肿瘤组织的破坏情况，能够成为胶质瘤病理诊断分级的一个辅助参考指数。
[Abstract]:Objective: To study the relationship between the expression of p53 protein and the pathological grade of gliomas in magnetic Resonance Spectroscopy Imaging, MRSI). To explore whether MRSI metabolites can be used to assist the diagnosis and grading of central nervous epithelial tumors (gliomas) in clinical practice, and to determine the boundaries of surgery or radiotherapy before treatment. The expression of p53 protein helps to improve the accuracy of pathological diagnosis. Methods: The parenchyma of the tumor was measured in 32 patients who underwent conventional magnetic resonance imaging (MRS) and magnetic Resonance spectroscopic MRS (MRS) scan before operation and were diagnosed as gliomas by postoperative pathological examination. The metabolites of the normal white matter in the peritumoral edema and the contralateral brain, including choline Cho, N-acetylaspartate NAAN, creatinine (CRA), Cho / NAA / NAAP / CRCHO / CR value, were examined by routine pathological examination and immunohistochemical examination of p53 antigen after tumor resection. The expression of p53 was recorded and the correlation between the recorded values and the location and pathological grade of glioma was analyzed. Results: 1. Changes of MRS metabolites ratio in different parts of gliomas The ratio of Cho / NAA / CRNAA / CR was different in tumor parenchyma, peritumoral edema and contralateral normal brain tissue. Comparing the ratio results with P0.05, there was statistical significance. The Cho / NAAAOCR of tumor parenchyma was larger than that of edema around tumor and normal contralateral brain tissue. The NAA/CR of the tumor parenchyma was smaller than that of the edema around the tumor and the contralateral normal brain tissue. 2. Changes of MRS metabolite ratio in gliomas of different pathological grades The value of Cho / NAAV / Cho / CR in high grade gliomas was significantly higher than that in low grade gliomas (P 0.05), and NAA / NAA / CR in high grade gliomas was significantly lower than that in low grade gliomas (P 0.05), which was significantly lower than that in low grade gliomas (P 0.05). Expression of 3.P53 in gliomas of different grades. The expression of p53 protein in 32 cases of glioma was positively correlated with the pathological grade (P 0.05), which showed a linear relationship. The higher the pathological grade was, the higher the expression of p53 was. Conclusion: 1. The ratio of metabolites of MRS in parenchyma, edema and contralateral normal brain tissue is different, the ratio of metabolite in parenchyma and edema is different, the ratio of metabolite in edema and normal brain tissue is also different. MRS can be used to judge the extent of tumor invading brain tissue and provide reference for determining the boundary of operation before operation. 2. The ratio of metabolites in MRS scan is correlated with the pathological grade of glioma, which can be used to judge the malignant degree of glioma, indicating that MRS is helpful for the clinical diagnosis of glioma. The expression of 3.P53 protein can reflect the damage of tumor tissue to a certain extent and can be an auxiliary reference index for the grade of pathological diagnosis of glioma.
【学位授予单位】：大理学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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