【摘要】：摘要背景與目的腫瘤表觀擴(kuò)散系數(shù)(Apparent Dffusion Coefficient,ADC)值與多個部位腫瘤的放療療效具有一定的相關(guān)性。我們的前期研究也證實(shí)鼻咽癌原發(fā)灶A(yù)DC值的早期變化程度與近期療效有明顯相關(guān)，但其具體機(jī)制不明。為進(jìn)一步探討鼻咽癌原發(fā)灶A(yù)DC值變化的病理機(jī)制，我們分析鼻咽癌原發(fā)灶A(yù)DC值與腫瘤組織細(xì)胞密度、微血管密度及核增殖指數(shù)的相關(guān)性。材料與方法對2010年4月至2011年11月間接受調(diào)強(qiáng)放療的局部晚期鼻咽癌患者，，分別于治療前及放療兩周時行常規(guī)MRI及DWI檢查，b值為0、800s/mm~2，測量鼻咽癌原發(fā)灶的ADC值。對鼻咽癌治療前活檢組織的病理切片進(jìn)行HE染色及免疫組化染色，計(jì)算腫瘤細(xì)胞密度、微血管密度及核增殖指數(shù)。分析鼻咽癌治療前的ADC值、放療2周與治療前ADC的差值與腫瘤細(xì)胞密度、微血管密度及核增殖指數(shù)的相關(guān)性。結(jié)果共79例鼻咽癌最終入組，T3期33例，T4期46例。鼻咽癌原發(fā)灶放療前ADC值為(8.15±1.28)x10~(-4)mm~2/s (最小值5.24x10~(-4)mm~2/s--最大值12.1x10~(-4)mm~2/s)；放療兩周后ADC值為(13.32±2.44) x10~(-4)mm~2/s (最小值9.1x10~(-4)mm~2/s---最大值19.4x10~(-4)mm~2/s)；兩個時間點(diǎn)ADC值的差值（5.16±2.33) x10~(-4)mm~2/s (最小值1.68x10~(-4)mm~2/s---最大值10.95x10~(-4)mm~2/s)）。鼻咽癌活檢組織的腫瘤細(xì)胞密度為（54±19）%(最小值4%---最大值88%)，微血管密度為每高倍視野66.46±23.94個(最小值18個---最大值116個)，核增殖指數(shù)為6.89±3.18分(最小值0分---最大值12分)。鼻咽癌原發(fā)灶放療前的ADC值與腫瘤細(xì)胞密度、微血管密度及核增殖指數(shù)的無明顯相關(guān)性(P值分別為0.896、0.517和0.201。兩個時間點(diǎn)的ADC值變化與腫瘤細(xì)胞密度呈負(fù)相關(guān)(r=-0.426，P＜0.001)；與微血管密度成正相關(guān)(r=0.429, P＜0.001)；與核增殖指數(shù)無明顯相關(guān)(P=0.820)。放療前ADC值與年齡、T分期呈線性相關(guān)，與細(xì)胞密度、微血管密度、核增殖指數(shù)、是否化療、病理類型無線性相關(guān)；兩個時間點(diǎn)的ADC值變化與細(xì)胞密度、CD34及年齡呈線性相關(guān)。結(jié)論鼻咽癌放療早期的ADC值變化程度可能與腫瘤細(xì)胞密度和微血管密度有關(guān)，這可能是其預(yù)測放療療效的病理學(xué)基礎(chǔ)。
[Abstract]:Background and objective the apparent diffusion coefficient (Apparent Dffusion Coefficient,ADC) of tumor was correlated with the radiotherapy effect of multiple tumors. Our previous study also confirmed that the early change of ADC in primary nasopharyngeal carcinoma was significantly correlated with the recent curative effect, but the specific mechanism was unclear. In order to further investigate the pathological mechanism of ADC changes in primary nasopharyngeal carcinoma (NPC), we analyzed the correlation between ADC value and tumor cell density, microvessel density and nuclear proliferation index in primary nasopharyngeal carcinoma (NPC). Materials and methods patients with locally advanced nasopharyngeal carcinoma receiving indirect intensity modulated radiotherapy from April 2010 to November 2011 were examined by routine MRI and DWI before treatment and two weeks after radiotherapy. The b value was 0.800s / mm2. The ADC values of primary nasopharyngeal carcinoma (NPC) were measured. HE staining and immunohistochemical staining were used to calculate tumor cell density, microvessel density and nuclear proliferation index. The ADC value before treatment and the correlation between the difference of ADC and tumor cell density, microvessel density and nuclear proliferation index in 2 weeks after radiotherapy and before treatment were analyzed. Results there were 79 cases of nasopharyngeal carcinoma, 33 cases in T3 stage and 46 cases in T 4 stage. The ADC value of primary nasopharyngeal carcinoma before radiotherapy was (8.15 鹵1.28) x 10 ~ (-4) mm~2/s (the minimum value was 5.24 x 10 ~ (-4) mm~2/s-- 12.1x10 ~ (-4) mm~2/s). The ADC value was (13.32 鹵2.44) x 10 ~ (-4) mm~2/s (minimum value 9.1 x 10 ~ (-4) mm~2/s- 19.4 x 10 ~ (-4) mm~2/s) after two weeks of radiotherapy. The difference of ADC value between two time points (5.16 鹵2.33) x 10 ~ (-4) mm~2/s (minimum value 1.68 x 10 ~ (-4) mm~2/s- maximum 10.95 x 10 ~ (-4) mm~2/s).) The cell density of nasopharyngeal carcinoma biopsy tissue was (54 鹵19)% (the minimum value was 4-88%), and the microvessel density was 66.46 鹵23.94 (minimum 18-maximum 116) per high power field. The nuclear proliferation index was 6.89 鹵3.18 (minimum 0-maximum 12). There was no significant correlation between ADC value and tumor cell density, microvessel density and nuclear proliferation index (P = 0.896, 0.517 and 0.201, respectively) before radiotherapy in primary nasopharyngeal carcinoma. The changes of ADC were negatively correlated with tumor cell density (r = -0.426, P < 0.001), positively correlated with microvessel density (r = 0.429, P < 0.001), and not correlated with nuclear proliferation index (P < 0. 820). There was no linear correlation between ADC value and age, T stage, cell density, microvessel density, nuclear proliferation index, chemotherapy or not, and pathological type. The changes of ADC value at two time points were linearly correlated with cell density, CD34 and age. Conclusion the changes of ADC in early stage of radiotherapy may be related to tumor cell density and microvessel density, which may be the pathological basis for predicting the therapeutic effect of radiotherapy for nasopharyngeal carcinoma.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R739.63

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