在体磁共振氢质子波谱联合环氧合酶-2评价人脑胶质瘤生物学行为

发布时间：2018-03-08 17:49

  本文选题：脑胶质瘤　切入点：在体磁共振波谱　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：实验目的:随着世界卫生组织发布最新的中枢神经系肿瘤分类及分级标准,更多微细水平评价胶质瘤成为临床标准和研究方向。本研究旨在探讨在人脑胶质瘤中,在体磁共振波谱(proton magnetic resonance spectroscopy)主要物质代谢和环氧化酶-2(cyclooxygenase-2,COX-2)表达的情况,并探讨两者的相关性及作用,以共同评价脑胶质瘤生物学行为,为胶质瘤的个体化治疗和评价提供更多更准确的评价指标。材料与方法:自2014年9月-2016年4月期间,于于山东大学齐鲁医院神经外科进行治疗的各级别的幕上脑胶质瘤患者中,收集其中临床资料完整且病理明确,满足入组条件的患者共39例,其中男性23例,女性16例,年龄范围24～66岁,平均为47岁。所有病例均为单发原发性脑胶质瘤,未接受任何治疗,其他系统无肿瘤相关性疾病。患者术前,于我院放射科磁共振室行颅脑平扫、增强及多体素1H-MRS检查,测量主要代谢物:胆碱类物质(choline,3.22ppm))、N-乙酰天门冬氨酸(N-acetyl aspartate,2.02 ppm)、肌酸(creatine,3.02 ppm)等的比值,并以解剖学对称位置的无肿瘤脑正常组织作为对照。肿瘤的磁共振形态学和波谱代谢分析均由两位有经验的放射科医师独立评估。术中根据肿瘤的实体部分选取标本取样区域。由我院病理科高年资的神经病理医师对照CNS肿瘤分类标准,将病理标本分为Ⅰ-Ⅳ级,其中Ⅰ级3例,Ⅱ级15例,为低级别组;Ⅲ级6例,Ⅳ级15例,为高级别组。同时,由另外有资质的病理医师对肿瘤标本进行环氧合酶-2(COX-2)免疫组化染色,并计算出其阳性表达率。应用SPSS 17.0软件进行数据分析处理。采用参数和非参数检验,包括相关性分析、COX生存风险模型等,评估1H-MRS和COX-2的关系以及两者联合共同评价高级别胶质瘤(high grade glioma,HGG)手术后序贯放疗后的病人生存风险。实验结果:1.COX-2的表达在低级别(LGG)和高级别胶质瘤(LGG)之间有显著不同(P0.01)。不同程度表达的COX-2与肿瘤区磁共振波谱的Cho/Cr值呈正相关(r = 0.49,P= 0.013),并表现出与性别、年龄、肿瘤位置无显著相关性。2.肿瘤区Cho/Cr、NAA/Cr、Cho/NAA值与正常对照侧有明显差异(P0.01)。在各病理级别的人脑胶质瘤中,磁共振波谱的代谢物比值也存在明显差异(P0.01)。3.在接受肿瘤切除和术后放疗的高级别胶质瘤患者中,单因素变量分析显示COX-2的高表达与生存期缩短相关(P = 0.048)。多因素生存分析提示COX-2、Cho/Cr值和年龄是HGG患者重要的预后指标。结论:1.在体磁共振波谱的Cho/Cr值和COX-2在人脑胶质瘤中表达水平呈正相关。2.两者与人类高级别胶质瘤术后-放疗后病人的总体生存率相关,并可以联合以提供更多角度和信息来评估人脑胶质瘤的生物行为。
[Abstract]:Objective: with the latest classification and classification of central nervous system tumors published by the World Health Organization (WHO), more microscopical evaluation of glioma has become a clinical standard and research direction. In vivo magnetic resonance spectroscopy (MRI) of proton magnetic resonance spectroscopy) and the expression of cyclooxygenase-2 (COX-2) in vivo, and the correlation and role of them in order to evaluate the biological behavior of gliomas. Materials and methods: from September 2014 to April 2016, patients with supratentorial gliomas were treated at the Department of Neurosurgery, Qilu Hospital, Shandong University. A total of 39 patients, including 23 males and 16 females, were collected with complete clinical data and clear pathology, including 23 males and 16 females, aged from 24 to 66 years, with an average age of 47 years. All the patients were single primary gliomas. No treatment was received, and no tumor-associated diseases were found in other systems. Before operation, the patients underwent craniocerebral plain scan, enhancement and multibody 1H-MRS examination in the magnetic resonance ventricle of our radiology department. The ratios of the main metabolites: cholinetocholine 3.22 ppm, N-acetyl aspartate 2.02 ppm-1, creatine 3.02 ppm, etc., were measured, and the results showed that the ratio of N-acetyl aspartate, creatine, creatine, creatine, creatine, creatine, creatine, creatine, creatine, etc. The MRI morphology and spectral metabolic analysis of the tumor were independently evaluated by two experienced radiologists. The tumor was selected according to the solid part of the tumor during the operation. Area of specimen sampling. CNS tumor classification criteria were compared by neuropathologists of our hospital with seniority in pathophysiology. Pathological specimens were divided into grade 鈪，

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