本文選題：腦膠質(zhì)瘤　切入點(diǎn)：在體磁共振波譜　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：實(shí)驗(yàn)?zāi)康?隨著世界衛(wèi)生組織發(fā)布最新的中樞神經(jīng)系腫瘤分類及分級(jí)標(biāo)準(zhǔn),更多微細(xì)水平評(píng)價(jià)膠質(zhì)瘤成為臨床標(biāo)準(zhǔn)和研究方向。本研究旨在探討在人腦膠質(zhì)瘤中,在體磁共振波譜(proton magnetic resonance spectroscopy)主要物質(zhì)代謝和環(huán)氧化酶-2(cyclooxygenase-2,COX-2)表達(dá)的情況,并探討兩者的相關(guān)性及作用,以共同評(píng)價(jià)腦膠質(zhì)瘤生物學(xué)行為,為膠質(zhì)瘤的個(gè)體化治療和評(píng)價(jià)提供更多更準(zhǔn)確的評(píng)價(jià)指標(biāo)。材料與方法:自2014年9月-2016年4月期間,于于山東大學(xué)齊魯醫(yī)院神經(jīng)外科進(jìn)行治療的各級(jí)別的幕上腦膠質(zhì)瘤患者中,收集其中臨床資料完整且病理明確,滿足入組條件的患者共39例,其中男性23例,女性16例,年齡范圍24～66歲,平均為47歲。所有病例均為單發(fā)原發(fā)性腦膠質(zhì)瘤,未接受任何治療,其他系統(tǒng)無(wú)腫瘤相關(guān)性疾病�；颊咝g(shù)前,于我院放射科磁共振室行顱腦平掃、增強(qiáng)及多體素1H-MRS檢查,測(cè)量主要代謝物:膽堿類物質(zhì)(choline,3.22ppm))、N-乙酰天門冬氨酸(N-acetyl aspartate,2.02 ppm)、肌酸(creatine,3.02 ppm)等的比值,并以解剖學(xué)對(duì)稱位置的無(wú)腫瘤腦正常組織作為對(duì)照。腫瘤的磁共振形態(tài)學(xué)和波譜代謝分析均由兩位有經(jīng)驗(yàn)的放射科醫(yī)師獨(dú)立評(píng)估。術(shù)中根據(jù)腫瘤的實(shí)體部分選取標(biāo)本取樣區(qū)域。由我院病理科高年資的神經(jīng)病理醫(yī)師對(duì)照CNS腫瘤分類標(biāo)準(zhǔn),將病理標(biāo)本分為Ⅰ-Ⅳ級(jí),其中Ⅰ級(jí)3例,Ⅱ級(jí)15例,為低級(jí)別組;Ⅲ級(jí)6例,Ⅳ級(jí)15例,為高級(jí)別組。同時(shí),由另外有資質(zhì)的病理醫(yī)師對(duì)腫瘤標(biāo)本進(jìn)行環(huán)氧合酶-2(COX-2)免疫組化染色,并計(jì)算出其陽(yáng)性表達(dá)率。應(yīng)用SPSS 17.0軟件進(jìn)行數(shù)據(jù)分析處理。采用參數(shù)和非參數(shù)檢驗(yàn),包括相關(guān)性分析、COX生存風(fēng)險(xiǎn)模型等,評(píng)估1H-MRS和COX-2的關(guān)系以及兩者聯(lián)合共同評(píng)價(jià)高級(jí)別膠質(zhì)瘤(high grade glioma,HGG)手術(shù)后序貫放療后的病人生存風(fēng)險(xiǎn)。實(shí)驗(yàn)結(jié)果:1.COX-2的表達(dá)在低級(jí)別(LGG)和高級(jí)別膠質(zhì)瘤(LGG)之間有顯著不同(P0.01)。不同程度表達(dá)的COX-2與腫瘤區(qū)磁共振波譜的Cho/Cr值呈正相關(guān)(r = 0.49,P= 0.013),并表現(xiàn)出與性別、年齡、腫瘤位置無(wú)顯著相關(guān)性。2.腫瘤區(qū)Cho/Cr、NAA/Cr、Cho/NAA值與正常對(duì)照側(cè)有明顯差異(P0.01)。在各病理級(jí)別的人腦膠質(zhì)瘤中,磁共振波譜的代謝物比值也存在明顯差異(P0.01)。3.在接受腫瘤切除和術(shù)后放療的高級(jí)別膠質(zhì)瘤患者中,單因素變量分析顯示COX-2的高表達(dá)與生存期縮短相關(guān)(P = 0.048)。多因素生存分析提示COX-2、Cho/Cr值和年齡是HGG患者重要的預(yù)后指標(biāo)。結(jié)論:1.在體磁共振波譜的Cho/Cr值和COX-2在人腦膠質(zhì)瘤中表達(dá)水平呈正相關(guān)。2.兩者與人類高級(jí)別膠質(zhì)瘤術(shù)后-放療后病人的總體生存率相關(guān),并可以聯(lián)合以提供更多角度和信息來評(píng)估人腦膠質(zhì)瘤的生物行為。
[Abstract]:Objective: with the latest classification and classification of central nervous system tumors published by the World Health Organization (WHO), more microscopical evaluation of glioma has become a clinical standard and research direction. In vivo magnetic resonance spectroscopy (MRI) of proton magnetic resonance spectroscopy) and the expression of cyclooxygenase-2 (COX-2) in vivo, and the correlation and role of them in order to evaluate the biological behavior of gliomas. Materials and methods: from September 2014 to April 2016, patients with supratentorial gliomas were treated at the Department of Neurosurgery, Qilu Hospital, Shandong University. A total of 39 patients, including 23 males and 16 females, were collected with complete clinical data and clear pathology, including 23 males and 16 females, aged from 24 to 66 years, with an average age of 47 years. All the patients were single primary gliomas. No treatment was received, and no tumor-associated diseases were found in other systems. Before operation, the patients underwent craniocerebral plain scan, enhancement and multibody 1H-MRS examination in the magnetic resonance ventricle of our radiology department. The ratios of the main metabolites: cholinetocholine 3.22 ppm, N-acetyl aspartate 2.02 ppm-1, creatine 3.02 ppm, etc., were measured, and the results showed that the ratio of N-acetyl aspartate, creatine, creatine, creatine, creatine, creatine, creatine, creatine, creatine, etc. The MRI morphology and spectral metabolic analysis of the tumor were independently evaluated by two experienced radiologists. The tumor was selected according to the solid part of the tumor during the operation. Area of specimen sampling. CNS tumor classification criteria were compared by neuropathologists of our hospital with seniority in pathophysiology. Pathological specimens were divided into grade 鈪，

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