人体肝癌病理形态发生和预测诊断价值的图像分析研究  

Image analysis on the pathological morphogenesis and forecasting diagnosis of human hepatocarcinoma

作　　者：章宗籍[1] 申丽娟[1] 欧阳明[2] 黄润[1] 张华献[1] 何云[2] 徐国枢 

机构地区：[1]昆明医学院病理学教研室,昆明650031 [2]云南大学实验中心图像分析室,昆明650091

出　　处：《中国体视学与图像分析》2000年第4期230-234,共5页Chinese Journal of Stereology and Image Analysis

摘　　要：目的 :阐明肝细胞DNA含量及组织细胞形态学在人体肝癌发生过程中的变化规律 ,筛选能预测诊断肝癌发生的指标并建立诊断方法。方法 :利用图像分析技术对 67例正常肝、轻度慢性肝炎、重度慢性肝炎、小结节肝硬变、大结节肝硬变、癌旁肝硬变和肝细胞癌分别作了 13项参数的形态定量研究和肝细胞DNA含量测定分析 ;应用方差分析和逐步判别分析筛选具有诊断意义的参数 ,建立判别函数方程 ,编制计算机诊断软件。结果 :从慢性肝炎、肝硬变、癌旁肝硬变到HCC ,反映核大小的参数和核浆比逐渐增大 ,而反映细胞大小的参数则逐渐减小 ,呈规律性变化 ;肝细胞DNA含量测定发现肝炎病毒所致慢性肝炎及大结节肝硬变多倍体化受到明显抑制 ,小结节肝硬变肝细胞明显多倍体化 ,HCC均为异倍体型肿瘤 ;形态计量及DNA含量测定癌旁肝硬变的多种细胞参数介于其它类型肝硬变与HCC之间 ,与其它肝硬变组间有显著的差异。逐步判别分析分别筛选了 6项形态参数和 5项肝细胞倍体指标建立了形态计量和细胞倍体判别函数方程。结论 :从细胞定量的角度为人体HCC的肝炎———肝硬变———肝癌发生模式提供了有力的证据 ;根据对癌旁肝硬变的研究 ,提出了“癌前肝硬变”的概念 ;“癌前肝硬变”的临床发现和监测 ,对于早期肝癌的预测诊断有重要的意?Objective To explained the changes in DNA contents and morphometry of human hepatocytes in hepatocarcinoma and it's relative liver diseases. Furthermore, to select the parameters of hepatocytes and establish the method which can forecast and diagnosis hepatocarcinoma. Methods The nuclear DNA contents and 13 morphometric parameters of hepatocytes in 67 human cases were measured by using an automated image analyser in normal liver, mild chronic hepatitis, severe chronic hepatitis, micronodular cirrhosis, macronodular cirrhosis, pericarcinoma cirrhosis (PC) and hepatocellular carcinoma (HCC). Variance (q-test) and stepwise discrimination analysis analyzed the data. Then the valued parameters that can be used to diagnosis tumor were selected to set up the equation of discriminational function. The pathodiagnosis software were developed. Results The values of nucleus parameters increased gradually and those of cell parameters decreased gradually in the sequence of chronic hepatitis, cirrhosis without tumor, pericarcinoma cirrhosis and HCC. The results of the DNA content measurement showed: The Polyploidization process was inhibited in chronic hepatitis and macronodular cirrhosis, all HCCs were aneuploid tumors; and the Predominant polyploidization can be seen in MINC. The ploidy distributions, percent of binucleated and the majority of cellular parameters in PC are intermediate between HCCs and other non-cancinous lesions. The difference was statistically significant. Six of 13 morphometric parameters and 5 parameters of ploidy processed by stepwise discriminational analysis were chosen to set up two equations of discriminational functions. Conclusions These mophometric studies support the carcinogenesis process of HCC: hepatitis→cirrhosis→HCC. A concept of “precanceruos cirrhosis” was put forward. It may be significant to diagnosis early hepatocarcinoma by determine precanceruos cirrhosis.

关 键 词：肝癌 病理形态发生 诊断 图像分析 

分 类 号：R735.7[医药卫生—肿瘤]