彩色多普勒超声检测乳头状甲状腺癌血流及病理微血管密度与颈部淋巴结转移的关系

Relationship between intratumoral blood flow assessed by color doppler, pathological microvessel density and cervical lymph node metastasis in papillary thyroid carcinoma

目的探讨彩色多普勒超声检测甲状腺乳头状癌(PTC)血流、病理微血管密度与颈部淋巴结转移的关系。方法采用彩色多普勒超声检测90例PTC内的血流信号,计测收缩期峰值流速(Vmax)、阻力指数(RI),同时采用免疫组化技术检测肿瘤内以CD105标记的微血管密度(MVD),分析Vmax、RI与MVD的相关性及其和PTC颈部淋巴结转移的关系。结果PTC的血流检出率(98.78%)显著高于甲状腺滤泡性腺瘤(50%)(连续校正χ2值=33.68,P<0.01),PTC的血流级别也显著高于腺瘤(似然比值=43.13,P<0.01);PTC的Vmax(75.72±20.62)、RI值(0.73±0.14)分别显著高于腺瘤的Vmax(33.80±4.15)、RI值(0.35±0.06)(t'=17.74,P<0.01;t'=19.53,P<0.01);PTC的MVD值(63.0±18.81)显著高于腺瘤的MVD值(15.73±5.13)(t'=23.39,P<0.01)。有颈部淋巴结转移的59例PTC的MVD值(76.18±4.98)、Vmax(90.24±4.41)及RI(0.82±0.05)分别显著高于无淋巴结转移的31例PTC的MVD值(38.01±3.92)、Vmax(48.10±4.62)及RI(0.56±0.09)(t=-37.03,P<0.01;t=-42.37,P<0.01;t'=-16.03,P<0.01)。而且,MVD与Vmax、MVD与RI和Vmax与RI明显正相关(r=0.721,P<0.01;r=0.789,P<0.01;r=0.66,P<0.01)。结论彩色多普勒超声检测PTC的血流参数Vmax、RI与MVD呈正相关,两者一致性反映了PTC的血管生成特性与其颈部淋巴结转移密切相关,两者的互补性结合可为PTC术前、术后临床诊治、预后判断提供有价值的信息。

[Objective] To explore the relationship between intratumoral blood flow assessed by color Doppler, pathological microvessel density and cervical lymph node metastasis in papillary thyroid carcinoma （PTC）. [Method] The intratumor flow signal of PTC was detected by color Doppler ultrasound in 90 patients. Risistance index（R1） and maximal velocity （Vmax） were used for analysis. Microvessel density marked by antibody CD105 was derived from immunohistochemisty technique. The correlations among Vmax, RI, and MVD were analyzed. The relations between above indices and cervical lymph node metastasis of PTCs were also investigated statistically. [Resuits] The intratumoral blood flow incidence of PTC（98.78%） was significantly higher than that of thyroid follicular adenoma（50%） （continuity correction χ2=33.68, P 〈0.01）. The blood flow grade was significantly higher than that of thyroid folhcular adenoma （likelihood ratio=43.13, P 〈0.01）. The values of Vmax（75.72±20.62）, RI（0.73±0.14） and MVD（63.0±18.81） were significantly higher than those （33.80±4.15）, （0.35±0.06）, （15.73±5.13） of adenoma （t＇ =17.74, P 〈0.01; t＇ =19.53, P 〈0.01; t＇ =23.39, P 〈0.01）. The values of MVD, Vmax and RI of 59 PTCs with cervical lymph node metastasis （76.18±4.98）, （90.24±4.41）, （0.82±0.05） were significantly higher than those of 31 PTCs without cervical lymph node metastasis（38.01±3.92）, （48.10±4.62）, （0.56±0.09） （t =-37.03, P 〈0.01; t=-42.37, P 〈0.01; t＇ =-16.03, P 〈0.01）. Furthermore, there was a positive linear correlation between MVD and Vmax, MVD and RI, Vmax and RI respectively （r =0.721, P 〈0.01; r=0.789, P 〈0.01; r =0.66, P 〈0.01）. [Conclusion] Vmax and RI detected by color Doppler ultrasound are positively correlated with MVD, which unanimously echoes the angiogenesis of PTC strongly associated with cervical lymph node metastasis. They are mutually supplementary so as to provide beneficial information for clinical diagnosis and treatment, prediction of prognosis of PTC before or after operation.