甲状腺实性结节的彩色多普勒超声和免疫组织化学研究

Color Doppler flow imaging and CD34, VEGF immunohistochemical study of the solid thyroid nodules

目的 应用彩色多普勒超声结合免疫组织化学检查探讨甲状腺实性结节的血管生成特征.方法 手术前观察55例患者共56个甲状腺实性结节（甲状腺乳头状癌28个,结节性甲状腺肿23个,腺瘤4个,桥本病1个）的彩色多普勒特征;术后病理标本行CD34、VEGF免疫组织化学染色.结果 甲状腺良恶性结节在血管走行和局部血流丰富方面存在显著性差异.75%恶性结节血管走行不规则或欠规则,64.3%存在局部血流丰富或可疑;89.3%良性结节血管走行规则,71.4%无局部血流丰富.恶性病灶CD34计数[（37.31±11.55）个/HP]明显高于良性病灶[（29.02±8.32）个/HP,P=0.04].良恶性结节VEGF表达具有显著差异,恶性结节表达高于良性结节（P＜0.01）.结论 甲状腺恶性结节较良性结节血管走行不规则、空间分布不对称,血管生成活跃.

Objective To evaluate angiogenesis of the benign and malignant solid thyroid nodules with color Doppler ultrasound and immunohistochemistry staining. Methods Fifty-six solid thyroid nodules in 55 patients （28 papillary thyroid cancer, 23 goiter, 4 adenoma, 1 Hashimoto＇ s disease） were observed before surgery with color Doppler ultrasound. Pathological specimens of paraffin-embedded were immunohistochemically stained with CD34 and VEGF antibody. Results There were significant differences between the benign and malignant thyroid nodules in vascular morphology and regional rich blood flow. The irregular or less irregular vessels were found in 75 % of the malignant nodules. Regional rich blood flow or suspicious regional rich blood flow were found in 64. 3% of malignant nodules. The regular vessels were found in 89. 3% of the benign nodules, non-regional rich blood flow was found in 71.4% of the benign nodules. The number of CD34 in malignant lesions [（37.31 ± 11.55）/HP] was significantly higher than benign lesions [（29. 02 ± 8.32）/HP, P = 0.04]. There was a significantly difference of VEGF expression between the benign and malignant nodules which was higher in malignant nodules than in benign nodules（P 〈 0.01）. Conclusions Compared with the benign nodules, the vessles in malignant thyroid nodules were irregular,the distribution of vessles was asymmetry and angiogenesis was active.