垂体腺瘤质地的多因素相关分析

Multiple factors analysis for the consistency of pituitary adenoma

目的对垂体腺瘤质地进行多因素相关分析,以指导垂体腺瘤质地的术前评估和手术入路选择。方法回顾性分析73例垂体腺瘤患者的临床表现、影像学及手术资料,术前测定患者MRI T2加权像上的瘤体与白质信号比。根据术中所见将肿瘤质地分为质地软(50例)和质地硬(23例)两类。采用天狼猩红染色法检测肿瘤胶原含量,并以免疫组织化学SP二步法检测不同质地垂体腺瘤中转化生长因子-β1(TGF-β1)和金属蛋白酶组织抑制因子1(TIMP1)的表达。结果垂体腺瘤质地与患者的性别、肿瘤大小、肿瘤类型和生长方式无明显关系。质地软与质地硬肿瘤组织中,其白质信号比分别为2.2 0 3±0.3 6 1和1.0 6 8±0.2 0 4,胶原含量分别为(8.0 0 0±2.4 7 5)%、(2 9.3 8 8±1 4.7 7 2)%,两者差异均具有统计学意义(t=6.748,P<0.05),且胶原含量与信号强度比值呈负相关(r=-0.787,P<0.0 5);TGF-β1表达量分别为0.6 2±0.2 3和0.2 8±0.4,TIMP1表达量分别为0.5 3±0.1 5和0.2 5±0.1 7,两者表达均与胶原含量呈正相关(r=0.7 8 1,P<0.0 5;r=0.4 6,P<0.0 5)。结论垂体腺瘤质地变硬的显著病理特征是胶原过度沉积,TGF-β1和TIMP1可能在垂体腺瘤质地变化中起重要作用,MRI T2加权相上的瘤体与白质信号比有助于术前预测垂体腺瘤质地,从而决定手术入路选择。

Objective To conduct multiple factors analysis for the consistency of pituitary adenoma so as to guide its preoperative evaluation and to choose appropriate surgical approach. Methods Clinical, image and surgical data of 73 patients with pituitary adenoma were reviewed respectively. The signal ratios of the tumors to white matters in T2 weighted MRI were measured preoperatively. According to the surgical finding, tumor consistency was divided into two types： the soft （50 cases ） and the hard （23 cases ）. Collagen content within the tumors was detected by means of Sirius red stain and the expression of TIMP1 （tissue inhibitors of metalloproteinasel ） and TGF-~I （transforming growth factor-~l ） was detected with immunohistochemistry. Results The consistency of pituitary adenoma had no significant relationship with their clinical characteristics such as gender, tumor size, tumor types and their growth way. The signal ratios of the tumors to white matters in T2 weighted MRI were （2. 203 ± 0. 361 ） and （ 1. 068：1： 0. 204 ） and collagen contents within the tumors were （ 8. 000 ±2. 475 ） % and （ 29. 388 ± 14. 772 ） % respectively in the soft and hard groups. The difference between two groups was significant（ t = 6. 748, P 〈 0.05 ）. Collagen content was negatively correlated to the signal ratios of thej tumors to white matters in T2 weighted MRI（r = -0. 787,P 〈0. 05）. The expression amounts of TGF-131were（0. 62 ±0. 23） and（0. 28 ± 0.40 ） , and those of TIMP1 were （ 0.53 ± 0.15 ） and （ 0.25 ± 0.17 ） , respectively in the hard and soft groups.Both of them were positively correlated with their collagen content （ r = 0 . 7 8 1 , P 〈 0 . 0 5 ; r = 0 . 4 6 , P 〈 0.05 ）. Conclusion The significant pathological feature is collagen deposition in harden adenomas. TGF-β1 and TIMP 1 may play an important role in the formation of consistency of pituitary adenoma. MRI T2 weighted phase of the tumor and white matter signal ratio of the tumor can be used to predict the consistency of adenoma, then to choose appropriate surgical approach.