荧光素钠导航下切除胶质母细胞瘤范围及分子病理学标志物表达的对比分析  

Comparative analysis on resection range of glioblastoma in navigation of fluorescein sodium and expression of molecular pathology markers

作　　者：田海龙[1] 王益华[1] 郭振涛[1] 姜彬[1] 殷鑫[1] 王超超[1] 何伟[1] 和政 王志刚[1] 

机构地区：[1]山东大学齐鲁医院(青岛)神经外科,山东青岛266000

出　　处：《生物医学工程与临床》2016年第3期251-254,255,256,共6页Biomedical Engineering and Clinical Medicine

基　　金：国家自然科学基金资助项目(81360373);山东大学齐鲁医院(青岛)科研启动基金资助项目(QDKY2015LH01)

摘　　要：目的分析荧光素钠（FL）标记下,胶质母细胞瘤（GBM）肿瘤实质、瘤脑边界、瘤周水肿的荧光显影程度,探讨肿瘤分子病理学标志物在肿瘤不同区域的表达,提供术中根据荧光性质评估肿瘤的组织学特征的线索和证据,提高荧光导航技术在胶质瘤手术中的应用水平。方法选择2014年1月至2015年6月山东大学齐鲁医院（青岛）术前经MRI诊断的GBM患者23例,其中男性14例,女性9例;年龄34-70岁,平均年龄44岁。行手术切除,术中利用FL将肿瘤染色标记,根据荧光影像（强荧光、弱荧光、无荧光）判定肿瘤的边界并切除肿瘤,比较术中所见与病理组织检查结果（包括光学显微镜检查和免疫组织化学方法检测P53、GFAP、CD28和Ki67＋的表达）。结果术后病理诊断证实23例肿瘤中,GBM18例,包括多形性GBM 15例（混合间变性星形细胞瘤2例）,巨细胞GBM 3例（混合间变性星形细胞瘤1例）。18例GBM荧光主要表现：肿瘤实质呈强荧光18例（100%）;瘤脑边界呈强荧光12例（66.67%）,弱荧光3例（16.67%）,无荧光3例（16.67%）;瘤周水肿无强荧光显影,弱荧光13例（72.22%）,无荧光显影5例（27.78%）（P〈0.05）。18例GBM免疫组织化学检测结果提示,在肿瘤实质、瘤脑边界和瘤周水肿等不同肿瘤区域,P53和GFAP表达水平差异无统计学意义（P=0.25、0.49）,CD28、Ki67表达水平差异有统计学意义（P〈0.05）。结论 FL标记GBM,肿瘤不同区域荧光显影程度不一,肿瘤不同区域和荧光显影部位其分子病理学标志物的表达不同;综合分析GBM荧光显影和分子病理学标志物表现,有助于术中分辨肿瘤浸润范围和预后判断。Objective To analyze the fluorescence imaging property of glioblastoma（GBM） tumor parenchyma, brain-tumor border, peri-tumoral edema marked by fluorescein sodium（FL） and investigate the expression of tumor molecular pathology markers in different regions of tumor, and provide clues and evidence for evaluation of tumor characteristics by fluorescence properties for improvement in glioma surgery. Methods From January 2014 to June 2015 in Qilu Hospital of Shandong University（Qingdao）, 23 cases of GBM diagnosed by MRI were enrolled, included 14 males and 9 females, aged 34- 70 years old with mean age of 44 years old. All of patients were performed surgery to remove tumors by FL staining method and using fluorescence imaging（strong-fluorescence, weak-fluorescence and non-fluorescence） to determine the boundaries of tumor. The fluorescence images and pathological results were compared in expression of P53, GFAP, CD28 and Ki67＋by light microscopy and immunohistochemical（IHC）. Results After surgery, 18 cases of GBM were confirmed by pathology, included 15 of multiform GBM（2 cases of mixed anaplastic astrocytoma）, 3 of giant cell GBM（mixed anaplastic astrocytoma in 1 case）. Test results showed that 18 cases of tumor parenchyma demonstrated strong-fluorescence property（100.00 %）; brain-tumor border with strong-fluorescence in 12 cases（66.67 %）, 3 cases（16.67 %） with weak-fluorescence and non- fluorescence in 3 cases（16.67 %）; peritumoral edema was none strong-fluorescence imaging, weak fluorescence in 13 cases（72.22 %） and non-fluorescence in 5 cases（27.78 %）（P〈0.05）. The results of IHC in 18 GBM showed that in tumor area, brain-tumor border and peritumoral edema, the expression level of GFAP and P53 were no significantly different（P = 0.25, 0.49）, while expression level of CD28 and Ki67 expression level were significantly different（P〈0.05）. Conclusion It is demonstrated that there are different tumor fluorescence imaging degree and molecular pathology e

关 键 词：胶质母细胞瘤 荧光素钠 荧光显影 肿瘤实质 瘤脑边界 分子生物学指标 病理组织 

分 类 号：R739.41[医药卫生—肿瘤] R651[医药卫生—临床医学]