【作者】 王震；

【导师】 吕长虹；

【作者基本信息】 重庆医科大学 ， 病理学， 2003， 硕士

【摘要】 目的 本实验主要通过研究侵袭性垂体腺瘤的临床-病理特点和E-cad、nm23、MMP-9及其抑制因子TIMP-1在腺瘤中的表达，探讨侵袭性垂体腺瘤的判别标准、侵袭机制及预后相关因素。 方法 根据术中观察和影像学检查将47例患者分为侵袭性垂体腺瘤组（23例）和非侵袭性垂体腺瘤组（24例），应用免疫组化SP法检测垂体腺瘤激素的分泌及上述侵袭相关的基因蛋白的表达，并结合临床病理特点和随访资料对比作差异显著性检验及相关分析。 结果 临床-病理方面，侵袭性垂体腺瘤组中肿瘤体积、非功能性腺瘤和非分泌型腺瘤的比例显著高于非侵袭性组（P＜0.01），侵袭性腺瘤比例随体积增大而增加（P＜0.05），侵袭性与非侵袭性腺瘤组间在年龄、病程、核分裂、核异型性、细胞多形性、组织坏死、组织学分类和组织学构型方面无显著性差异（P＞0.05）。基因蛋白表达方面，侵袭性垂体腺瘤组E-cad、nm23表达显著低于非侵袭组，非分泌型垂体腺瘤E-cad表达显著低于分泌型，E-cad表达与垂体腺瘤体积成负相关关系（P＜0.05）；MMP-9表达和MMP-9表达超过TIMP-1的比例在侵袭性垂体腺瘤组显著高于非侵袭性组（P＜0.05），但上述基因蛋白表达与功能性分类、组织学分类及组织学构型无明显相关性（P＞0.05）。多因素分析中，体积、nm23和MMP-9表达对垂体腺瘤侵袭性有显著的影响（P＜0.05）。 结论 E-cad、nm23和MMP-9在垂体腺瘤侵袭的发生和进展过程中起重要作用。肿瘤体积等垂体腺瘤的临<WP=5>床-病理特点和上述E-cad等三种基因蛋白表达特征对评估垂体腺瘤的侵袭性及预后有重要参考价值。更多还原

【Abstract】 Objective To study invasiveness standard, invasive behavior mechanism and prognosis of pituitary adenomas by analysis of the clinical and pathological features of invasive pituitary adenomas and expression of E-cad、nm23、MMP-9 and TIMP-1. Methods Forty-seven surgically removed pituitary adenomas was divided into invasive group twenty-three cases and noninvasive group twenty-four cases on the basis of radiological and intraoperative observation. The expression characteristics of above-mentioned gene proteins and clinical and pathological features were determined and compared between the two groups with follow-up data.Results Significant clinical and pathological difference existed between two groups in tumor size（P＜0.01）, functional and endocrine classification（P＜0.05），except in age ,interval time between symptom appearance and admission, incidence of mitosis, nucleus atypia , cell pleomorphism and tissue necrosis. Moreover, proportion of invasive adenoma increased with volume of tumor（P＜0.01）.The invasive group had a significantly lower expression of E-cad and nm23 than that of noninvasive group，endocrine inactive group expressed significantly lower E-cad than endocrine active group（P＜0.05）; there was a negative correlation between expression of E-cad and grade of tumor volume(P<0.05). In addition, the invasive group had a significantly higher expression of MMP-9 and proportion of MMP-9 overexpressing TIMP-1 than that of noninvasive group（P＜0.05). In multi-factor analysis, volume, nm23 and MMP-9 had a significant effect on invasiveness of pituitary adenomas（P＜0.05）.Conclusion E-cad, nm23, MMP-9 may play a key role in occurrence and<WP=7>progress of invasiveness in pituitary adenomas. Analysis of the clinical and pathological features and expression characteristics of E-cad, nm23, MMP-9 of pituitary adenomas may better evaluate invasiveness and prognosis of pituitary adenomas.更多还原