阴道镜联合病理学微血管密度评价宫颈CIN

Evaluation for cervical disease CIN by colposcopy associated with pathological micro-vessel density

目的：检测CIN不同病变程度及阴道镜下不同血管表现的微血管密度（MVD）表达，揭示该指标与宫颈CIN病理分化的关系，评估MVD及阴道镜下血管表现不同对不同病变程度CIN的诊断及判断预后的价值。方法：2009年1月-8月复旦大学妇产科医院宫颈疾病诊疗中心诊治的宫颈癌前病变（CIN）165例，其中CINI18例，CINⅡ24例，CINm123例。正常对照组19例。采用免疫组化SP法，分别检测各组病理标本MVD。对其中72例阴道镜下表现为点状和镶嵌状血管和异形血管的活检组织进行MVD测定。结果：CINⅠ和CINⅢ的平均MVD之间存在统计学差异（P〈0．05）。CINⅡ和CINⅢ的平均MVD之间无统计学差异。CIN与MVD之间有相关性（r=0．3168，P〈0．05）。点状血管表现者平均MVD显著低于镶嵌者平均MVD（P〈0．01）；更显著低于异形血管表现者的平均MVD（P〈0．01）；但镶嵌与异形血管之间MVD均无统计学差异。阴道镜下血管形态与MVD之间有相关性（r=0．4542，P〈0．05）。结论：CIN病变程度及阴道镜下不同血管表现与MVD呈正相关。阴道镜下观察不同血管表现联合检测MVD可能在CIN的早期诊断、预后判断中具有一定意义。

Objective： Microressel density （MVD） in different grades of CIN and diverse vessel appearances under colposcope were detected to reveal the relationship between MVD and CIN,and evaluate the role of MVD and vessel appearances under eolposcope in diagnosis and prognosis of CIN. Methods：From Jan. 2009 to Aug. 2009,we collected 165 cases with CIN in Cervical Diseases Treatment ＆ Diagnosis Center, Ob. ＆ Gyn. Hospital of Fudan University,of which 18 cases were CIN Ⅰ ,24 CIN Ⅱ , 123 CINⅢ and 19 controls were collected. All cases and controls were tested for MVD with SP method by immunohistochemistry. Furthermore, 72 cases with punctuation,mosaic appearance and abnormal vessels under colposcope were biopsied and tested for MVD. Results ： Mean MVD of CIN I and CIN m were statistically different （P〈0.05）. However,there was no statistical difference in MVD between CIN Ⅱ and CIN m. Pearson correlation analysis showed that CIN was positively correlated with MVD（r= 0.3168,P 〈0.05）. MVD of tissues with punctuation was significantly lower than those with mosaic （P〈 0.01 ）;and more lower than those with abnormal vessels （P〈0.01）. However, there was no difference in MVD between tissues with mosaic and abnormal vessels. Pearson correlation analy- sis showed that colposcopic vessel appearance was positively correlated with MVD（r=0. 4542, P〈0.05）. Conclusion： MVD is closely related to CIN levels and colposcopic vessel appearance. Overall, observation of different vessel appearances under colposcope combined with MVD may be of some importance in early diagnosis and prognosis of CIN.