【摘要】 目的　探讨肺癌发生发展过程中肿瘤血管生成和血液供应 ,以及血管内皮细胞生长因子(VEGF)及其受体Flk 1与肿瘤血管生成的关系。方法　 10 0只Wistar大鼠左肺下叶支气管灌注致癌质碘油 ,分批处死获取肺鳞癌癌变及进展期病变标本 ,使用油画颜料染成黄、绿两种颜色的液态硅橡胶分别灌注支气管动脉与肺动脉 ,免疫组化检测病变组织中VEGF、Flk 1的表达及vWF染色切片上的微血管密度 (MVD)。结果　经支气管动脉灌注黄色液态硅橡胶显示 ,肿瘤病灶呈黄色的新生血管团与曲张的支气管动脉相连通 ,镜下见癌巢间质肿瘤微血管腔充盈硅橡胶颗粒 ;经肺动脉灌注绿色液态硅橡胶 ,肿瘤区绿色的血管呈不连续的枯树枝、断枝、残枝状 ,与肿瘤血管不连续 ,镜下肿瘤微血管腔无硅橡胶颗粒。原位癌的MVD计数 ( 3 9.5 0± 12 .60 )与不典型增生 ( 8.92± 3 .80 )及侵袭癌 ( 61.0 5± 19.92 )比较 ,差异均有显著性 (P <0 .0 1)。从支气管粘膜上皮增生→鳞状化生→不典型增生→原位癌→侵袭癌 ,VEGF和Flk 1阳性系数逐渐升高。MVD与VEGF和Flk 1表达均呈正相关 (r分别为 0 .9798和 0 .90 78,P <0 .0 0 5 )。结论　肺癌新生血管形成是大鼠肺鳞癌发生发展的重要现象 ,新生的肿瘤血管与支气管动脉相连通 ,与肺动脉不相连通 ,证明肺鳞癌发生更多还原

【Abstract】 Objective To investigate the origin of tumor blood vessel and blood supply during pulmonary carcinogenesis, and the relationship between vascular endothelial growth factor (VEGF), its receptor Flk 1 and angiogenesis. Methods One hundred Wistar rats were instilled with 3 methylcholanthrene (MCA) and diethylinitrosamine (DEN) to induce pulmonary squamous cell carcinoma through left lower lobe bronchus. To acquire different pathological phase during the carcinogenesis, rats were killed in 15, 35, 55, 65, 75 days after instillation. Yellow and green silastics were respectively injected into the bronchial and pulmonary arteries of 30 rats in 55, 65, 75 days after instillation. Intertumor microvessel density (MVD) was marked by anti von Willebrand factor monoantibody. VEGF and Flk 1 expression were examined by immunohistochemistry. Results In the tumor area the tumor blood vessels were yellow and connected with distorted bronchial artery and very few green incomplete branches of pulmonary artery were seen. Silastic particles could be seen in the disordered tumor blood vessels by microscope after bronchial artery perfusion. There was no silastic particles in the carcinoma interstitial blood vessels after pulmonary artery perfusion. MVD count significantly increased in carcinoma in situ (39.50±12.60) and infiltrative carcinoma (61.05±19.92) as compared to atypical hyperplasia (8.92±3.80)(both P<0.01), and the increased vessels originated from bronchial artery, but not pulmonary artery. The expression of VEGF and Flk 1 increased during pulmonary carcinogenesis. The positive coefficients of VEGF and FLK 1 expressions became higher and higher from epithelial proliferation to squamous metaplasia, to atypical hyperplasia, to carcinoma in situ and finally to infiltrative carcinoma. There was significant correlation between MVD and VEGF expression (r=0.979 8, P<0.005), as well as between MVD and Flk 1 expression (r=0.907 8, P<0.05). Conclusion Angiogenesis is the important phenomenon of the rat pulmonary carcinogenesis and the newly formed blood vessels in tumor connect with the branches of bronchial artery, but not pulmonary artery. This confirms that the blood supply of pulmonary carcinoma is from bronchial artery, not from pulmonary artery. VEGF and Flk 1 are closely related to angiogenesis of tumor.更多还原