实验性大鼠恶性胸膜间皮瘤病理改变的相关性分析

Correlated Analysis of Pathological Changes in Induced Rat MPM

目的探讨大鼠MPM各种病理因素间相互关系,为MPM的诊断、治疗、预后评估提供更多的理论依据.方法Wistar大鼠100只作为实验组,右侧胸膜腔闭式染尘法注入石棉纤维混悬液40 mg,对照组20只注入等量灭菌生理盐水.每天观察动物的一般状况,每月称体重1次,死亡或垂死动物尸体解剖,肉眼观察胸、腹腔.结果有效实验组MPM66只,胸膜增生14例,胸膜阴性12例.对照组14只中4只胸膜增生,10只胸膜阴性.大体病理学改变分为结节型、斑片型、巨块型.组织病理学为上皮型、纤维型、混合型三型.按肿瘤异型性程度分高、中、低分化.双侧胸水45例,单侧9例,均为血性.45例(68.18%)向胸壁、肺组织、膈肌、纵隔等周围组织浸润.大鼠MPM组织学类型与大体分型、肿瘤浸润性之间无相关性.但组织类型与分化程度、胸水具有一定的相关性.结论上皮型MPM分化差、胸水多、预后较差;纤维型分化好、胸水少、预后较好.分化程度与肿瘤浸润有关,中、低分化肿瘤浸润比例较高.生存期并非单一因素,而是多种因素的综合作用.

Objective To explore the relationship of the pathological features of MPM of rats in order to supply more theoretical basis for the diaglosis, treatment and prognosis of MPM. Methods 10Q Wistar rats in the test group were injected 2 mL suspension of asbestos with a concentration of 20 mg/mL into the closed right chest cavity, 20 rats in the control group were injected into sterilized saline water by same method. The general condition of rats was observed everyday, the weight of rats was detected every month. Rats were dissected immediately when they died or were dying. The regions of suspected lesions through naked eye observation were sampled. Results There were66 cases of MPM, 14 cases of pleural hyperplasia and 12 cases without pleural change in the test group. There were only 4 cases of pleural hyperplasia and 10 cases without pleural change in the control group. MPM were classified into 3 kinds according to gross pathology： mass type in 9 cases （13.64%） ;nodular type in 49 cases （72.73%） plaque type in 9 cases （13.64% ）. Histological changes included epithelial type in 13 cases （19.7%） ; fibrous type in 33 cases （50%） ; mixed type in 20 cases （30.3%）. According to heterogeneity, MPM were also classified into： higher differentiation, middle differentiation, and lower differentiation. There was no significant correlation between gross and microscopy observation, between differentiation of epithelial type is low, often accompanying with large volume of bloody pleurorrhea and worse prognosis. The differentiation of fibrous MPM is higher, with few pleurorrhea and better prognosis. The degree of the differentiation is relative to tumor＇s invasion. The ratio of the invasion was higher in the middle or low differentiation tumors. Living span is affected from a lot of factors.