促肾上腺皮质激素治疗伽玛刀术后顽固性肿瘤周围脑水肿的研究  

Study of adrenocorticotropic hormone in treatment of stubborn peritumoral vasogenic brain edema after γ-knife therapy

作　　者：卢刚[1] 吴旭[1] 吴越[2] 赵仲生[3] 河野宽一 王坚[1] 

机构地区：[1]浙江省人民医院神经外科,浙江杭州310014 [2]浙江省人民医院药剂科,浙江杭州310014 [3]浙江省人民医院病理科,浙江杭州310014 [4]日本福井医科大学脑神经外科

出　　处：《实用肿瘤杂志》2008年第1期16-19,共4页Journal of Practical Oncology

基　　金：浙江省人事厅出国留学人员科研基金资助(编号2006-2-28)

摘　　要：目的研究促肾上腺皮质激素（ACTH）治疗伽玛刀术后顽固性肿瘤周围血管源性脑水肿（PVBE）的疗效及其作用机制。方法对79例伽玛刀术后常规脱水治疗无效的顽固性PVBE患者予以ACTH治疗，并对其中再次手术获取的27例肿瘤标本进行组织学和超微结构研究。结果ACTH治疗前79例患者的血清ACTH测定值与健康对照组差异无显著性（P〉0．05），水肿指数（EI）为4．7～9．6，首次治疗1个月后PVBE-EI降至1．1～2．9（P〈0．05）。27例伽玛刀治疗后顽固性PVBE的主要病理改变为病灶坏死和间质增生，肿瘤血管壁可呈纤维样坏死变性；VEGF和PCNA染色阳性表达明显降低；电镜检查肿瘤血管内皮细胞皱缩扁平，内皮细胞间连接缝隙增大甚至中断。结论ACTH可明显降低伽玛刀术后顽固性PVBE的EI，其疗效与病灶周围脑水肿区域血脑屏障的受损及修复程度有关并呈一定的药物依赖性变化。Objective To investigate the efficiency and mechanism of adrenocorticotropic hormone （ACTH） in the treatment of stubborn peritumoral vasogenic brain edema （PVBE） after γ-knife therapy. Methods ACTH therapy was administrated in 79 cases with stubborn PVBE after γ-knife therapy who had no response to routine dehydraton. Twentyseven tumor samples from operation were studied by using light and transmission electric microscopy. Results There was no significantly statistical difference of the ACTH serum value measured between 79 cases and control group. The index of PVBE in 79 patients was 4. 7～ 9. 6 before ACTH therapy. After first administration of ACTH, the PVBE index was significantly decreased to 1.1～2.9 （P〈0.05）. The main histological changes in 27 patients with surgical operation after γ-knife therapy were necrosis and interstitial hyperplasia,and perivascular fibrinoid necrosis was also observed. The positive expressions of PCNA and VEGF stain were then decreased. Endothelium often showed attenuation and surface infoldings under the transmission electric microscopy. Widely separation between endothelial cells was also detected. Conclusion ACTH therapy may effectively decrease the index of PVBE in patients with stubborn PVBE caused by γ-knife therapy. Its efficiency is mainly dependent on the both damaged and repaired degree of brain-blood barrier in the brain tumors and also on the changes in a medicine-dependent manner.

关 键 词：脑肿瘤 脑水肿 促肾上腺皮质激素 免疫组织化学 

分 类 号：R739.4[医药卫生—肿瘤]