本文選題：胃腸道間質(zhì)瘤 + 體層攝影術(shù)　； 參考：《石河子大學(xué)》2016年碩士論文

【摘要】：目的:1.探討胃間質(zhì)瘤(gastric stromal tumors,GST)的CT征象與腫瘤危險(xiǎn)度分級的關(guān)系及其價(jià)值。2.探討胃間質(zhì)瘤(GST)免疫組化指標(biāo)的表達(dá)情況及臨床意義。方法:1.回顧性分析106例經(jīng)CT及病理證實(shí)的GST的CT征象,分析內(nèi)容包括:年齡、性別、瘤體部位、大小、形態(tài)、生長方式、邊界、密度、實(shí)性部分強(qiáng)化程度、有無遠(yuǎn)處轉(zhuǎn)移。GST的危險(xiǎn)度分級標(biāo)準(zhǔn)采用2008版美國國立衛(wèi)生署(NIH)的危險(xiǎn)度分級,將危險(xiǎn)度分級分為低危組、中危組和高危組。采用SPSS20.0統(tǒng)計(jì)軟件,以GST各危險(xiǎn)度分級作為因變量(Y),各CT征象為自變量(X)對GST危險(xiǎn)度分級進(jìn)行單因素和多因素Logistic回歸分析。先將GST患者的臨床資料:年齡、性別,CT征象包括瘤體部位、大小、形態(tài)、生長方式、邊界、密度、實(shí)性部分強(qiáng)化程度、有無遠(yuǎn)處轉(zhuǎn)移與GST危險(xiǎn)度分級進(jìn)行單因素分析,采用χ2檢驗(yàn),再選擇其中有顯著意義的因素進(jìn)行多因素Logistic回歸分析。P0.05為差異有統(tǒng)計(jì)學(xué)意義。2.回顧性分析81例經(jīng)病理證實(shí)的GST病例的常規(guī)HE染色切片和Envision二步法免疫組化切片。觀察指標(biāo)包括年齡、性別、瘤體部位、腫瘤大小、核分裂象和免疫組化指標(biāo)(CD117、CD34、DOG-1、Desmin、Ki-67、S-100和SMA)。GST的危險(xiǎn)度分級標(biāo)準(zhǔn)采用2008版美國國立衛(wèi)生署(NIH)的危險(xiǎn)度分級,分為極低危組、低危組、中危組和高危組。采用SPSS20.0統(tǒng)計(jì)軟件,將GST病例的年齡、性別、瘤體部位、大小、核分裂象和危險(xiǎn)度分級與免疫組化指標(biāo)進(jìn)行單因素分析,采用χ2檢驗(yàn),P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.本組106例GST中,低危組46例,中危組27例,高危組33例。其中,年齡≤50歲21例,51~70歲66例,70歲19例。男性43例,女性63例。發(fā)生于胃底40例,胃體52例,胃竇14例。腫瘤大小≤5cm52例,5~10cm43例,10cm11例。形態(tài)規(guī)則69例,形態(tài)分葉37例。腔內(nèi)生長54例,腔外生長30例,混合生長22例。邊界清晰83例,邊界模糊23例。密度均勻44例,密度不均62例。實(shí)性部分輕度強(qiáng)化33例,中度強(qiáng)化22例,重度強(qiáng)化51例。遠(yuǎn)處轉(zhuǎn)移8例,腹腔內(nèi)轉(zhuǎn)移6例,淋巴結(jié)轉(zhuǎn)移2例。采用單因素分析,各組GST在腫瘤大小、形態(tài)、生長方式、邊界、密度、實(shí)性部分強(qiáng)化程度、遠(yuǎn)處轉(zhuǎn)移方面有統(tǒng)計(jì)學(xué)差異(P0.05),而在年齡、性別、瘤體部位方面無統(tǒng)計(jì)學(xué)差異(P0.05);采用多分類Logistic回歸分析,腫瘤大小、形態(tài)和生長方式在預(yù)測GST惡性風(fēng)險(xiǎn)方面有統(tǒng)計(jì)學(xué)差異(P0.05)。2.本組81例GST中,CD117、CD34、DOG-1、Desmin、Ki-67、S-100和SMA的陽性率分別為98.8%、98.7%、91.5%、21.7%、40.3%、25.0%和31.4%。胃間質(zhì)瘤CD117、CD34、DOG-1、Desmin、S-100和SMA的陽性表達(dá)與年齡、性別、瘤體部位、大小、核分裂象、危險(xiǎn)度分級之間無統(tǒng)計(jì)學(xué)差異(P0.05);Ki-67的陽性表達(dá)與年齡、性別、瘤體部位之間無統(tǒng)計(jì)學(xué)差異(P0.05),與大小、核分裂象、危險(xiǎn)度分級之間有統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1.CT作為一種快速、有效的檢查方法,在腫瘤大小、形態(tài)、生長方式、邊界、密度、實(shí)性部分強(qiáng)化程度、遠(yuǎn)處轉(zhuǎn)移方面的征象,有助于評估GST的危險(xiǎn)度分級。2.腫瘤大小、形態(tài)和生長方式可預(yù)測GST的惡性風(fēng)險(xiǎn),為臨床診斷、術(shù)前評估、治療方案制定及預(yù)后評價(jià)提供一定的幫助。3.CD117,CD34和DOG-1的聯(lián)合檢測對于診斷GST具有重要價(jià)值。4.Desmin,S-100和SMA可用于GST的鑒別診斷。5.Ki-67的表達(dá)結(jié)合GST的大小、核分裂象和危險(xiǎn)度分級,有助于評估GST的預(yù)后。
[Abstract]:Objective: 1. to explore the relationship between the CT signs of gastric stromal tumors (GST) and the classification of tumor risk and the value of.2. to investigate the expression and clinical significance of the immunohistochemical indexes of gastric stromal tumor (GST). Methods 1. retrospective analysis of the CT signs of GST confirmed by CT and pathology in 106 cases, including age, sex, and tumor site The size, shape, growth mode, boundary, density, solid partial intensification, the risk degree classification of distant metastasis.GST was graded by the 2008 edition of the National Health Department (NIH), and the risk grade was divided into low risk group, middle risk group and high risk group. The SPSS20.0 statistical software was used to classify the risk degree of GST as the dependent variable (Y). A single factor and multiple factor Logistic regression analysis of the GST risk grade were performed for the CT signs (X). First, the clinical data of the GST patients: age, sex, CT signs including the site of the tumor, size, shape, growth mode, boundary, density, solid partial intensification, and a single factor analysis of distant metastasis and GST risk classification. The multiple factor Logistic regression analysis was used by the x 2 test, and the multiple factor Logistic regression analysis was used to analyze.P0.05. The difference was statistically significant. The conventional HE staining section and the Envision two step immunohistochemistry section of 81 cases of pathologically confirmed GST cases were analyzed. The observation indexes included age, sex, tumor size, tumor size, and nuclear division. Image and immunohistochemical markers (CD117, CD34, DOG-1, Desmin, Ki-67, S-100 and SMA) risk grading of.GST was classified by the 2008 edition of the National Health Department (NIH) risk grade, divided into the extremely low risk group, the low risk group, the middle risk group and the high risk group. The SPSS20.0 statistics software was used to use the SPSS20.0 statistics software to make the GST cases age, sex, tumor site, size, mitotic image and danger. A single factor analysis of risk grade and immunohistochemistry, P0.05 was statistically significant by chi 2 test. Results: 1. in 106 cases of GST, 46 in low risk group, 27 in middle risk group and 33 in high risk group. Among them, 21 cases of age 50 years old, 66 cases of 51~70 years old, 70 years 19 cases, male 43 cases, female 63 cases, gastric antrum cases, gastric antral cases. Size less than 5cm52, 5~10cm43 and 10cm11, morphological rules 69 cases, morphological lobulation in 37 cases, 54 cases of intravaginal growth, 30 cases of external growth, 22 cases of mixed growth, 83 cases with clear boundary, 23 cases of boundary blurring. 33 cases of density uniformity, 33 cases of mild strengthening, moderately strengthened 22, severe intensified 51. Metastasis 8 cases, intraperitoneal rotation 6 cases and 2 cases of lymph node metastasis were analyzed by single factor analysis. The size, morphology, growth mode, boundary, density, solid partial enhancement and distant metastasis of GST were statistically different in each group (P0.05), but there was no statistical difference in age, sex, and tumor location (P0.05). Multiple classification Logistic regression analysis, tumor size, and morphology were used. The positive rates of CD117, CD34, DOG-1, Desmin, Ki-67, S-100 and SMA were 98.8%, 98.7%, 91.5%, 21.7%, 40.3%, 25%, and 31.4%. gastric stromal tumors, respectively, in the 81 cases of GST in the prediction of the risk of malignant GST. There was no statistical difference between the division images and the risk grade (P0.05); there was no statistical difference between the positive expression of Ki-67 and the age, sex, and the site of the tumor (P0.05), and there was a statistical difference between the size, the nuclear mitotic image and the risk grade (P0.05). Conclusion: 1.CT is a fast and effective method of examination in the size, shape, growth pattern, and edge of the tumor. The boundary, density, real partial enhancement, and distant metastasis contribute to assessing the size of the GST risk grade.2. tumor, and the morphology and growth patterns can predict the malignant risk of GST, providing some help for clinical diagnosis, preoperative assessment, treatment scheme formulation and prognosis evaluation, and combined detection of CD34 and DOG-1 for the diagnosis of GST. The value of.4.Desmin, S-100 and SMA can be used for the differential diagnosis of GST with the expression of.5.Ki-67, the size of GST, the classification of the mitotic image and the risk degree, which can help to evaluate the prognosis of GST.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 林海峰;徐國森;佟丹丹;耿敬姝;;胃腸道間質(zhì)瘤的免疫組化觀察與臨床病理意義的研究[J];現(xiàn)代腫瘤醫(yī)學(xué);2013年06期

，

本文編號：1995303