本文關(guān)鍵詞： 骨巨細(xì)胞瘤 切除 復(fù)發(fā) 核磁共振 動(dòng)態(tài)增強(qiáng)核磁共振 惡變 骨巨細(xì)胞瘤 骨巨細(xì)胞瘤 MMP-9 逆轉(zhuǎn)錄聚合酶鏈反應(yīng) 免疫印跡法 免疫組化　出處：《上海交通大學(xué)》2015年博士論文　論文類型：學(xué)位論文

【摘要】：伴有軟組織腫塊的骨巨細(xì)胞瘤經(jīng)局部刮除術(shù)后復(fù)發(fā)的深入分析目的:通過回顧分析伴有軟組織腫塊的骨巨細(xì)胞瘤(GCTB)患者經(jīng)局部刮除術(shù)后復(fù)發(fā)率,尋找能預(yù)測(cè)與局部刮除術(shù)后復(fù)發(fā)有關(guān)的軟組織腫塊核磁共振影像特征。材料和方法:回顧分析48例伴有軟組織腫塊骨巨細(xì)胞瘤患者。所有患者均行局部刮除手術(shù)。所有病例按軟組織腫塊的MR影像及病理特征(如軟組織腫塊的大小、數(shù)量、邊界是否完整、周圍組織受累、軟組織腫塊MR信號(hào)強(qiáng)度、增強(qiáng)MR信號(hào)特征和Jaffe分級(jí))分組。各組局部刮除術(shù)后復(fù)發(fā)率差異比較采用卡方檢驗(yàn)(chi-square test)或卡方值校正的連續(xù)性檢驗(yàn)(chi-square test andχ2 value correction for continuity)。與局部刮除術(shù)后復(fù)發(fā)有關(guān)的軟組織腫塊MR影像特征的危險(xiǎn)因素評(píng)估采用多因素回歸分析檢驗(yàn)(multivariate logistic regression analysis)。p0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)果:在MR圖像上,當(dāng)骨巨細(xì)胞瘤伴有較大軟組織腫塊、多發(fā)軟組織腫塊或軟組織腫塊邊界不完整時(shí),采用局部刮除手術(shù)后復(fù)發(fā)率較高,結(jié)果具有統(tǒng)計(jì)學(xué)差異(p0.05)。在軟組織腫塊周圍組織受累、Jaffe分級(jí)組中,其局部刮除術(shù)后復(fù)發(fā)率之間沒有統(tǒng)計(jì)學(xué)差異(p0.05)。軟組織腫塊的大小、數(shù)量和邊界是否完整是骨巨細(xì)胞瘤病灶經(jīng)刮除術(shù)后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素(p0.05)。結(jié)論:當(dāng)GCTB伴有較大軟組織腫塊、多發(fā)軟組織腫塊或軟組織腫塊邊界不完整時(shí),采用局部刮除術(shù)后復(fù)發(fā)率較高。臨床遇到具有此類軟組織腫塊MR影像特征的GCTB患者,在選擇外科手術(shù)治療方案時(shí),其局部刮除術(shù)后較高的復(fù)發(fā)率需要充分考慮。三期對(duì)比增強(qiáng)核磁共振檢查在預(yù)測(cè)骨巨細(xì)胞瘤惡變的價(jià)值目的:通過對(duì)骨巨細(xì)胞瘤(GCTB)、復(fù)發(fā)良性骨巨細(xì)胞瘤(RBGCTB)、繼發(fā)惡性骨巨細(xì)胞瘤(SMGCTB)三期動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像上時(shí)間-信號(hào)強(qiáng)度曲線特征的比較,尋找能預(yù)測(cè)骨巨細(xì)胞瘤惡變的新線索。材料與方法:回顧分析21例經(jīng)手術(shù)病理確診為骨巨細(xì)胞瘤的患者。所有病例均在術(shù)后復(fù)發(fā)。其中,9例復(fù)發(fā)病例病理證實(shí)為SMGCTB,12例復(fù)發(fā)病例術(shù)后病理證實(shí)為RBGCTB。病例分為四組:A組:術(shù)前GCTB(n=9);B組:術(shù)后SMGCTB(n=9);C組:術(shù)前GCTB(n=12);D組:術(shù)后RBGCTB(n=12)。病灶在三期動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像上增強(qiáng)指數(shù)(EI)計(jì)算公式:EI(t)=[S(t)-S(0)]/S(0),其中S(0)是病灶T1加權(quán)平掃圖像上的平均信號(hào)強(qiáng)度,S(t)是病灶在動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像不同期相的信號(hào)強(qiáng)度(t分別為注射造影劑后30,60和180秒)。每組病灶在動(dòng)態(tài)對(duì)比增強(qiáng)MR檢查不同期相的增強(qiáng)指數(shù)差異檢驗(yàn)采用單因素方差分析(One-Way ANOVA analysis)。在三期動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像上,病灶的時(shí)間-信號(hào)強(qiáng)度增強(qiáng)曲線的上升和下降斜率值比較采用同樣方法。p0.05認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)果:在三期動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像上,SMGCTB的時(shí)間-信號(hào)強(qiáng)度曲線的特點(diǎn)是早期造影劑快速流入和延遲期造影劑快速廓清。GCTB和RBGCTB的時(shí)間-信號(hào)強(qiáng)度曲線的特點(diǎn)是早期造影劑快速流入和延遲期造影劑緩慢廓清。在三期動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像第一期相中,各組間的增強(qiáng)指數(shù)沒有統(tǒng)計(jì)學(xué)差異(p0.05)。在三期動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像的第二期和第三期中,各組間的增強(qiáng)指數(shù)存在統(tǒng)計(jì)學(xué)差異(p0.05)。B組(SMGCTB)增強(qiáng)指數(shù)較其他三組低。時(shí)間-信號(hào)強(qiáng)度曲線的上升斜率值在各組間無(wú)統(tǒng)計(jì)學(xué)差(p0.05)。時(shí)間-信號(hào)強(qiáng)度曲線下降斜率值在各組間存在統(tǒng)計(jì)學(xué)差異(p0.05)。B組(SMGCTB)下降斜率的平均絕對(duì)值較其他組高(p0.05)。結(jié)論:三期動(dòng)態(tài)對(duì)比增強(qiáng)MR圖像的時(shí)間-信號(hào)強(qiáng)度增強(qiáng)曲線特征可為預(yù)測(cè)骨巨細(xì)胞瘤術(shù)后惡變提供有價(jià)值的線索。動(dòng)態(tài)對(duì)比增強(qiáng)MR檢查是GCTB患者術(shù)前和術(shù)后重要的影像隨訪資料。骨巨細(xì)胞瘤邊緣組織和中央組織基質(zhì)金屬蛋白酶-9表達(dá)與MRI影像意義的初步研究目的:通過比較骨巨細(xì)胞瘤中央組織和邊緣組織MMP-9表達(dá)水平并對(duì)照MR圖像特征,以期發(fā)現(xiàn)腫瘤內(nèi)部不同部位MMP-9表達(dá)差異及其與MRI影像學(xué)意義,為腫瘤內(nèi)部不同部位腫瘤細(xì)胞采用不同靶點(diǎn)治療提供參考依據(jù)。材料與方法:收集經(jīng)手術(shù)后病理證實(shí)為骨巨細(xì)胞瘤并行局部瘤段切除手術(shù)患者新鮮標(biāo)本或石蠟固定標(biāo)本17例。每例標(biāo)本在病灶中央和邊緣各取材4處。其中4例標(biāo)本行半定量RT-PCR、Western blot蛋白免疫印跡法測(cè)定標(biāo)本MMP-9 m RNA和MMP-9蛋白的表達(dá)。所有標(biāo)本均行連續(xù)切片HE染色和MMP-9免疫組化染色。同時(shí),對(duì)GCTB邊緣組織和中央組織MMP-9免疫組化染色程度與MR圖像特征關(guān)系進(jìn)行評(píng)估。計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)誤(mean±standard error)表示。兩組資料樣本均數(shù)差異的檢驗(yàn)采用Student’s t-tests檢驗(yàn)。多組資料樣本均數(shù)檢驗(yàn)采用方差分析檢驗(yàn)(one-way analysis of variance ANOVA)或卡方值校正的連續(xù)性檢驗(yàn)(chi-square test orχ2 value correction for continuity)。各組間樣本均數(shù)兩兩差異檢驗(yàn)采用(Dunnett's post-test)檢驗(yàn)。分類變量樣本均數(shù)差異比較使用Chi-square test檢驗(yàn),p0.05被認(rèn)為有統(tǒng)計(jì)學(xué)差異。結(jié)果:在免疫組化染色病例中,GCTB邊緣組織MMP-9染色程度大于2級(jí)(++)時(shí),其陽(yáng)性率為77.94%,中央組織MMP-9染色程度大于2級(jí)(++)時(shí),其陽(yáng)性率為29.41%。兩者間具有統(tǒng)計(jì)學(xué)差異,p0.05。RT-PCR實(shí)驗(yàn)結(jié)果顯示GCTB邊緣組織、中央組織和周圍正常組織中MMP-9 m RNA相對(duì)表達(dá)水平分別為0.88±0.07、0.35±0.04和0.12±0.03,各組間有統(tǒng)計(jì)學(xué)差異,p0.05。Western blot實(shí)驗(yàn)結(jié)果顯示MMP-9蛋白在GCTB邊緣組織、中央組織和周圍正常組織相對(duì)表達(dá)水平分別為0.92±0.04,0.42±0.06和0.13±0.02,各組間有統(tǒng)計(jì)學(xué)差異,p0.05。GCTB邊緣組織MMP-9 m RNA和蛋白的相對(duì)表達(dá)水平較中央組織和周圍正常組織高。在MR圖像表現(xiàn)為局部骨質(zhì)破壞并軟組織腫塊形成的病例中,邊緣組織MMP-9免疫組化染色程度為2-3級(jí)的樣本數(shù)大于染色程度為0-1級(jí)的樣本數(shù),結(jié)果有統(tǒng)計(jì)學(xué)差異,p0.05。中央組織MMP-9染色程度的差異與MR圖像表現(xiàn)為局部骨質(zhì)破壞及軟組織腫塊形成之間無(wú)統(tǒng)計(jì)學(xué)差異,p0.05。GCTB邊緣組織和中央組織MMP-9染色程度差異與MR圖像表現(xiàn)為鄰近組織受累、MRI信號(hào)特征、MRI增強(qiáng)特征之間無(wú)統(tǒng)計(jì)學(xué)差異,p0.05。結(jié)論:骨巨細(xì)胞瘤邊緣組織MMP-9表達(dá)高于中央組織。骨巨細(xì)胞瘤邊緣組織MMP-9的高表達(dá)可能與局部骨質(zhì)破壞并軟組織腫塊有相關(guān)。如果以MMP-9作為骨巨細(xì)胞瘤生物學(xué)標(biāo)記物或潛在治療靶點(diǎn)時(shí),需考慮其在腫瘤內(nèi)部不同部位的差異表達(dá)。
[Abstract]:Giant cell tumor of bone with soft tissue masses by local scratch in-depth analysis for postoperative recurrence: through retrospective analysis of giant cell tumor of bone with soft tissue mass (GCTB) of patients with local curettage postoperative recurrence rate, finding predictive and local recurrence after curettage of the soft fabric image characteristics of mass on nuclear magnetic resonance materials and methods: a retrospective analysis of 48 cases with soft tissue mass in patients with giant cell tumor of bone. All patients underwent local curettage surgery. All cases according to MR imaging and pathological features of soft tissue tumors (such as soft tissue tumor size, number, boundary is complete, involvement of surrounding tissue, soft tissue mass MR signal intensity the enhanced MR signal characteristics and Jaffe classification) group. Each local recurrence rate after curettage was compared by chi square test (chi-square test) value continuity correction test or chi square (chi-square test and value correctio x 2 N for and continuity). Local curettage risk imaging features of soft tissue mass MR related factors of postoperative recurrence was assessed using multiple regression analysis test (multivariate logistic regression analysis.P0.05) that there were significant differences. Results: on MR images, when the size of bone cell tumor with large soft tissue mass, multiple soft tissue masses or soft tissue mass boundary is not complete, the local curettage high recurrence rate after surgery, the difference was statistically significant (P0.05). In the affected tissue surrounding soft tissue mass, Jaffe grade group, the local recurrence rate after curettage between no statistical difference (P0.05). Soft tissue tumor size, number and whether is the complete boundary of giant cell tumor of bone by scraping independent risk factors except postoperative recurrence (P0.05). Conclusion: when the GCTB with large soft tissue mass, multiple soft tissue mass or soft tissue mass boundary Is not complete, the local curettage high recurrence rate after operation. The clinical encounter with such a soft tissue mass MR imaging features of GCTB patients in the choice of surgical treatment, the local curettage after higher recurrence rate need to be fully considered. Three phase contrast enhanced magnetic resonance imaging examination in predicting malignant giant cell tumor of bone Objective: through the value of giant cell tumor of bone (GCTB), the recurrence of benign giant cell tumor (RBGCTB), secondary malignant giant cell tumor of bone (SMGCTB) compared to the time signal intensity curve characteristics of MR images of the three phase dynamic contrast enhancement, looking for new can predict malignant giant cell tumor of bone cable. Materials and methods: a retrospective analysis 21 patients with pathologically diagnosed with GCT. All cases were recurred after surgery. Among them, 9 cases of recurrent cases pathologically confirmed SMGCTB, 12 cases of recurrence of postoperative pathology confirmed RBGCTB. patients were divided into four groups: A 緇，

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