本文選題：神經(jīng)上皮性腫瘤 + 膠質(zhì)瘤�。� 參考：《大理學(xué)院》2014年碩士論文

【摘要】：目的： 研究磁共振波普成像(Magnetic Resonance Spectroscopy Imaging, MRSI)中的常見代謝物的值的變化規(guī)律，P53蛋白表達(dá)程度與膠質(zhì)瘤的病理分級的關(guān)系，探討臨床實(shí)際工作中是否能利用MRSI代謝物值輔助中樞神經(jīng)上皮性腫瘤（以下簡稱膠質(zhì)瘤）診斷分級，治療前確定手術(shù)或放療的邊界，利用P53蛋白的表達(dá)程度協(xié)助增加病理診斷準(zhǔn)確性。 方法： 選取32例術(shù)前經(jīng)做常規(guī)磁共振（Magnetic Resonance，MR）及磁共振波普（Magnetic Resonance Spectroscopy，MRS）掃描，且術(shù)后病理檢查確診為膠質(zhì)瘤的患者為研究對象。MRS檢查時，分別測量腫瘤實(shí)質(zhì)部、瘤周水腫部及對側(cè)大腦正常白質(zhì)的代謝物值，，包括膽堿(CHO), N-乙酰天門冬氨酸(NAA),肌酐(CR),記錄CHO/NAA，NAA/CR，CHO/CR值；術(shù)后腫瘤切除標(biāo)本行常規(guī)病理檢查及P53抗原的免疫組織化學(xué)檢查，記錄P53表達(dá)值；分析各部分各個記錄值與膠質(zhì)瘤部位，病理分級之間的相關(guān)性。 結(jié)果： 1.膠質(zhì)瘤不同部位MRS代謝物比值變化特點(diǎn) CHO/NAA，CHO/CR，NAA/CR值，在腫瘤實(shí)質(zhì)部，瘤周水腫部以及對側(cè)正常腦組織中比值均不同，將比值結(jié)果兩兩比較，P0.05，有統(tǒng)計學(xué)意義，腫瘤實(shí)質(zhì)部的CHO/NAA，CHO/CR大于瘤周水腫部與對側(cè)正常腦組織，腫瘤實(shí)質(zhì)部的NAA/CR小于瘤周水腫部與對側(cè)正常腦組織。 2.不同病理級別膠質(zhì)瘤MRS代謝物比值變化特點(diǎn) CHO/NAA，CHO/CR值在高級別組膠質(zhì)瘤（WHOIII-IV級）中明顯大于低級別組膠質(zhì)瘤（WHOI-II級），P0.05，有統(tǒng)計學(xué)意義；NAA/CR在高級別組膠質(zhì)瘤（WHOIII-IV級）中明顯小于低級別組膠質(zhì)瘤（WHOI-II級），P0.05，有統(tǒng)計學(xué)意義。 3.P53在不同級別膠質(zhì)瘤中的表達(dá)。 32例膠質(zhì)瘤患者腫瘤中的P53蛋白表達(dá)與病理分級呈正相關(guān)（P0.05），呈線性關(guān)系，可認(rèn)為病理級別越高，P53表達(dá)水平上升。 結(jié)論： 1.膠質(zhì)瘤腫瘤實(shí)質(zhì)部，瘤周水腫部，對側(cè)正常腦組織MRS代謝物比值是不同的，實(shí)質(zhì)部與水腫部代謝物比值不同，水腫部與正常腦組織代謝物比值亦不同，臨床實(shí)際工作中，可借助MRS用來輔助判斷腫瘤侵犯腦組織的范圍，從而為手術(shù)治療前確定手術(shù)的邊界提供參考依據(jù)。 2. MRS掃描的代謝物比值與膠質(zhì)瘤的病理分級存在相關(guān)性，可以用來幫助判斷膠質(zhì)瘤的惡性程度，說明MRS對膠質(zhì)瘤的臨床診斷分級有一定幫助。 3.P53蛋白的表達(dá)能夠在一定程度上反應(yīng)腫瘤組織的破壞情況，能夠成為膠質(zhì)瘤病理診斷分級的一個輔助參考指數(shù)。
[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.
【學(xué)位授予單位】：大理學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.41

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