胶质瘤瘤周水肿、病理级别、Ki-67表达三者相关性研究

Correlational study of peritumoral brain edema,histological grades and the expression of Ki-67 in glio-mas

目的：探讨胶质瘤患者瘤周水肿（ PTBE）程度、肿瘤病理级别、Ki-67阳性表达率三者之间的相关性。方法收集新疆自治区人民医院神经外科2010—2013年经手术切除，病理证实的胶质瘤患者病历资料及标本74例，根据术前磁共振成像（ MRI ）资料判断肿瘤 PTBE程度，免疫组织化学检测Ki-67表达情况，HE染色区别肿瘤病理级别。结果本组研究中90.54%（67/74）伴发PTBE，其中Ⅰ、Ⅱ、Ⅲ、Ⅳ级别组PTBE发生率各为100%（3/3）、78.95%（15/19）、83.33%（15/18）及100%（34/34）；75.68%（56/74）Ki-67表达呈阳性；Ⅰ、Ⅱ、Ⅲ、Ⅳ级别组阳性率分别为0、36.84%（7/19）、94.44%（17/18）、94.12%（32/34）；无水肿、Ⅰ度水肿与Ⅱ水肿组中Ki-67表达阳性率分别为57.14%（4/7）、60.00%（6/10）、80.70%（46/57）。经Kruskal-Wallis H检验，PTBE在不同级别胶质瘤的总体差异有统计学意义（H＝11.304，P＝0.010）；Ki-67在不同级别胶质瘤中总体差异有统计学意义（H＝38.530，P﹤0.05）；Ki-67在不同PTBE组中表达的总体差异有统计学意义（ H＝6.478，P＝0.039）。Spearman等级相关分析显示胶质瘤PTBE程度随肿瘤病理级别增加而增加（ r＝0.385，P＝0.001）；Ki-67表达阳性率随肿瘤病理级别增加而增加（ r ＝0.692，P ﹤0.05）；Ki-67表达阳性率随胶质瘤 PTBE 增加而增加（ r ＝0.256，P＝0.028）。结论术前根据PTBE的大小可预测肿瘤的恶性程度与增殖活性，Ki-67既可作为肿瘤增殖活性的指标，也可当做病理分级的重要依据。

Objective To explore the correlation of peritumoral brain edema（ PTBE）size,histologi-cal grades and the expression rate of Ki-67 in gliomas. Methods The data and specimens about 74 cases of gliomas in People＆#39;s Hospital of Xinjiang Uygur Autonomous Region during 2010-2013 were collected. All cases were confirmed by surgery and pathology. According to preoperative MRI,PTBE was graded. Immunohisto-chemical discriminate the expression of Ki-67. HE coloration distinguish the histological grades. Results In this study,90. 54%（67/74）patients occured PTBE,the incidence of PTBE inⅠ,Ⅱ,Ⅲ,Ⅳlevel of groups were 100%（3/3）,78. 95%（15/19）,83. 33%（15/18）,100%（34/34）. Ki-67 expression was positive in 75. 68%（56/74）patients,and the rates were 0,36. 84%（7/19）,94. 44%（17/18）,94. 12%（32/34） in Ⅰ,Ⅱ,Ⅲ,Ⅳ level of groups. The expression rate of Ki-67 was 57. 14%（4/7）,60. 00%（6/10）,and 80. 70%（46/57）in normal group,Ⅰ-level groups of PTBE,Ⅱ-level groups of PTBE. The result of Kruskal-Wallis H showed that the PTBE from different grades was statistically significant（H=11. 304,P=0. 010）. The expression rate of Ki-67 in different grade gliomas was statistically significant（H=38. 530,P﹤0. 05）, The difference of expression Ki-67 in gliomas of different PTBE was statistically significant（ H=6. 478,P=0. 039）. The result of Spearman rank correlation analysis showed that the PTBE level increased with the histo-logical grade up in gliomas（r=0. 385,P=0. 001）. The expression rate of Ki-67 increased with the histologi-cal grade up in gliomas（r=0. 692,P﹤0. 05）,and the expression rate of Ki-67 increased with the degree of PTBE up in glomas（ r =0. 256,P =0. 028 ）. Conclusion Accorrding to the PTBE size,the histological grades and proliferation ability of glioma can be judged pre-operation. Ki-67 can be used as the indicator of pro-liferation activity of tumor,and also be used as the important basis of histological grades.