彩色多普勒超声血流阻力指数与宫颈癌血管生成关系的研究

Relationship between color Doppler sonography resistance index and cervical carcinoma angiogenesis

摘要:

目的：初步观察经阴道彩色多普勒超声（transvaginal color Doppler flow imaging，TV-CDFI）的血流阻力指数（resistance index，RI）与肿瘤血管生成评价的金标准微血管密度（microvessal density，MVD）与宫颈癌临床分期之间的关系，从不同角度评价宫颈癌的血管生成状态，探讨TV-CDFI在宫颈癌诊断及预后中的应用价值。方法：收集贵阳市妇幼保健院住院病例，分为宫颈鳞癌组和对照组两组，每组各30例，其中宫颈鳞癌组均由病理学确诊，按肿瘤临床分期在Ⅰ、Ⅱ期各选15例。患者术前行TV-CDFI检查，检测宫颈鳞癌患者肿瘤内的血流情况，测其RI值，对照组检测子宫动脉RI值。取患者切除的宫颈标本制作组织切片，采用免疫组织化学Envision二步法检测宫颈鳞癌组和对照组宫颈组织中MVD表达情况。结果：对照组与宫颈鳞癌组比较，宫颈癌组TV-CDFI检测的RI值明显降低，而CD34标记的平均MVD水平显著升高，2组差异有统计学意义（P＜0.05）；宫颈鳞癌组MVD与RI成负相关（rs=-0.56，P＜0.05）；RI值改变与子宫颈鳞癌临床分期Ⅰ、Ⅱ期有关（P＜0.05），MVD值变化与临床分期Ⅰ、Ⅱ期无关。结论：RI、MVD可从不同角度很好地反映宫颈鳞癌的血管生成情况，二者呈负相关，用RI检测宫颈鳞癌的血管生成较MVD检测的敏感度更高且具有无创、可重复、术前获得的优点，在临床上可有更大的应用价值。

Abstract:

Objective：To observe the relationship among resistance index（RI） of transvaginal color Doppler flow imaging（TV-CD－FI），tumor angiogenesis evaluation criterion-microvessel density（MVD） and clinical stage，to evaluate carcinoma angiogenesis from different perspectives and to discuss the value of TV-CDFI in cervical cancer diagnosis and prognosis. Methods：Hospitalized pa－tients from the Maternal and Child Health Hospital of Guiyang were divided into the 2 groups：cervical cancer group（n=30） and con－trol group（n=30）. Patients in cervical cancer group were confirmed by pathology and were subdivided into two groups（n=15） accord－ing to clinical stage Ⅰ and Ⅱ. Patients were examined by TV-CDFI before operation. Morphological features of tumors，arterial blood flow signals within tumors and RI were recorded for later analysis. RI of uterine arteries was measured in control group. Cervical tis－sue slice were made by using excised cervical specimen of patients. Immunohistochemistry Envision method was adopted to detect MVD levels in cervical tissues in cervical cancer group and control group. Results：RI values detected by TV-CDFI were decreased significantly and CD34 marked MVD levels were increased markedly in cervical cancer group compared with those in control group，with statistical differences（P<0.05）. MVD and RI in cervical cancer group showed negative linear correlation（rs=-0.56，P<0.05）. Clini－cal stage Ⅰ and stage Ⅱ in cervical cancer were positively correlated with RI values，P<0.05，but not with MVD levels. Conclusions：Angiogenesis characteristics of cervical cancer can be reflected by RI and MVD，which are negative correlated.With the advantages of higher sensitivity，non-invasive，repetable and preoperation acquisition，RI is more effective in detecting angiogenesis of cervical can－cer than TV-CDFI and has greater values in clinical application.