多发性骨髓瘤MRI骨髓浸润模式与血管生成关系的研究

Study on the correlation between MRI patterns of marrow involvement and angiogenesis in myeloma

目的:探讨多发性骨髓瘤MRI骨髓浸润模式与血管生成的相关性。方法:以25例初诊MM患者为研究对象,进行传统影像学、血清肌酐、血清蛋白、β2微球蛋白、乳酸脱氢酶等检测,并根据Durie-Salmon分期系统进行分期。对骨髓瘤患者在初诊及治疗之前行脊柱T1WI、STIR和常规的T1WI增强扫描,分析骨髓瘤细胞在骨髓内的浸润模式。对照组包括非恶性血液病患者10例,其骨髓涂片及活检检查均证实为正常骨髓象。对研究组和对照组患者均进行骨髓活检及病理检查,免疫组化测定微血管密度(MVD),以CD34单抗标记微血管内皮细胞。另外,采集骨髓后分离上层血浆,采用ELISA法测定VEGF蛋白浓度,根据结果进行统计学分析。结果:初治MM患者骨髓上清VGEF水平及MVD高于健康对照组(P<0.05)。MRI骨髓弥漫性浸润的MM患者骨髓上清VGEF水平及MVD高于MRI骨髓成像正常或局灶性浸润的患者(P<0.05)。结论:MRI骨髓弥漫性浸润模式与血管生成密切相关。

Objective：To explore correlations between MRI patterns of marrow involvement and bone marrow an-giogenesis in myeloma. Methods：Twenty-five newly diagnosed myeloma patients were enrolled in this study. The level of serum creatinine,albumin,β2-micoglobulin,and Lactate Dehydrogenase were routinely detected. The pres-ence of bone involvement was documented with conventional skeletal surveys. Durie-Salmon staging system was ap-plied for staging. Spinal marrow were examined with MR imaging. T1-weighted images（T1WI）,short TI inversion re-covery（STIR）and enhanced T1WI were performed and analyzed for patterns of myelomatous involvement. 10 pait-ients with non-malignant hemotopoietic diaseases were enrolled in the control group,whose bone marrow were ap-proved to be not involved through bone marrow smear and biopsy. Microvessel density（ MVD）was determined by im-munohistochemical identification of microvascular endothelial cells in the bone marrow trephine biopsies using a hu-man monoclonal antibody against CD34. In addition,An enzyme-linked immunosorbent assay was used for the detec-tion of the serum vascular endothelial growth factor（ VEGF）. Results：The serum levels of VEGF and MVD in bone marrow of newly-diagnosed MM increased significantly compared with the control（P〈0. 05）. The extent of angio-genesis,as assessed by MVD in trephine biopsies and serum levels of VEGF increased in myeloma patients with dif-fuse MRI bone marrow pattern compared with patients with normal or focal pattern（P〈0. 05）. Conclusion：Diffuse MRI marrow pattern correlates with increased angiogenesis.