肝癌超声声像图与免疫组织化学指标的关系

Relationship between liver ultrasonography and immunohistochemistry indicators in patients with hepatocellular carcinoma

目的:探讨肝癌患者二维超声、彩色多普勒血流显像(color Doppler flow imaging,CDFI)、彩色能量血流显像(color power Dopper imagi n g a n g l o,C PA)与免疫组织化学指标的相关性.方法:选择62例肝癌(hepatocellular carcinoma,H C C)患者为研究对象,应用二维超声观察肝脏内肿块的形态、大小、边界、回声强度及内部回声情况,应用CDFI、CPA观察肿瘤区域及周边血供情况,并采用免疫组织化学SABC法观察p53及增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)的表达情况,并且测定微血管密度(microvessel density,MVD),分析影像学参数与免疫组织化学指标的相关性.结果:二维超声结果显示,MVD均值在形态、个数、回声、边界、均匀值、坏死程度分组中差异均有统计学意义(P<0.05).瘤体多发、瘤体边界不清、回声不均、内部伴坏死、伴门静脉癌栓者的p53蛋白及PCNA阳性表达均高于瘤体单发、边界清、内部回声均匀者(P<0.05).有转移组的MVD值、p53蛋白及PCNA阳性表达率均显著高于无转移组(P<0.05).不同CDFI分型中,Ⅲ型与Ⅰ型相比,MVD值、p53蛋白及PCNA表达均较高(MVD:55.26±18.47 vs 34.59±11.18,p53蛋白:9/9 vs 6/18,PCNA:9/9 vs 12/18),差异有统计学意义(P<0.05).不同CPA分型中,与Ⅲ型的MVD值相比,Ⅰ型的MVD值与Ⅱ型的MVD值均低于Ⅲ型(Ⅰ型,MVD:26.58±8.42vs 51.52±16.36,Ⅱ型:35.43±13.04 vs 51.52±16.36)(P<0.05).与Ⅰ型的p53、PCNA表达相比,Ⅱ型和Ⅲ型的p53蛋白、PCNA表达均高于Ⅰ型(Ⅱ型,p53蛋白:21/32 vs 3/18,Ⅲ型:12/12 vs 3/18)(Ⅱ型,PCNA:29/32 vs 6/18,Ⅲ型:12/12 vs 6/18)(均P<0.05).CDFI、CPA与MVD值、p53蛋白及PCNA表达间呈正相关,差异均有统计学意义(P<0.01).结论:二维超声、CDFI、CPA及与MVD、p53蛋白及PCNA有密切关系,在一定程度上可作为肝癌初筛方法,对临床肝癌的诊断具有重要价值.

AIM： To explore the correlation between immunohistochemistry indexes and two-dimensional ultrasound, color Doppler flow imaging （CDFI）, and color power angio （CPA） parameters in patients with hepatocellular carcinoma. METHODS： Sixty-two patients with hepatocellular carcinoma were included in this study. Two-dimensional ultrasonography was used to observe the morphology, size, border, the echo intensity and internal echo of the liver mass. The CDFI and CPA were used to observed tumor region and the surrounding blood supply. The expression of the p53 and PCNA was detected by the immunohistochemical SABC method. The change in microvessel density was measured. Correlation between radiographic parameters and immunohistochemical indexes was analyzed. RESULTS： MVD values differed significantly among the groups divided based on the shape, number, echo, borders, uniform values and necrosis degree revealed by two-dimensional ultrasound （all P 〈 0.05）. The p53 protein and PCNA expression in patients with multiple tumors, unclear tumor boundary, uneven echo, internal necrosis, or portal vein tumor thrombus was significantly higher than those with single tumors, clear tumor boundary, even echo, the absence of necrosis or portal vein tumor thrombus （all P 〈 0.05）. The 53 and PCNA protein expression was significantly higher in patients with metastasis than in those without metastasis （both P 〈 0.05）. MVD value, p53 protein and PCNA expression in CDFI grade III tumors were significantly higher than those in CDFI grade I tumors （MVD： 55.26 ± 18.47 vs 34.59 ± 11.18, p53 protein： 9/9 vs 6/18, PCNA： 9/9 vs 12/18, all P 〈 0.05）. MVD value in CPA grade I and II tumors were lower compared with CPA grade III tumors （26.58 ± 8.42, 35.43 ± 13.04 vs 51.52 ± 16.36）. The p53 protein and PCNA expression was significantly higher in CPA grade II and III tumors than in CPA grade I tumors （p53： 21/32, 12/12 vs 3/18; PCNA： 29/32, 12/12 vs 6/18） （all P 〈 0.05）. CDFI and CPA grades were positively correlated with MVD, p53 protein and PCNA expression （all P 〈 0.01）. CONCLUSION： Two-dimensional ultrasound, CDFI and CPA parameters are closely related to the p53 PCNA protein expression and MVD value, which could be used as useful tools for HCC screening and diagnosis.