结肠息肉癌变过程中内镜微血管特征与MVD IGF-1 STAT3表达相关性研究

Correlation of microvascular characteristics under narrow band imaging with MVD, IGF-1, and STAT3 expression during cancerization of colorectal polyp

目的:分析MVD、IGF-1、STAT3等血管生成因子在结肠癌及癌前病变组织中的表达与窄带成像内镜(NBI)下的微血管形态的相关性,探究内镜实时观测血管生成的可行性。方法:将普通白光内镜以及NBI内镜均诊断为结肠息肉样病变并经病理组织学证实的结肠早期癌、结肠腺瘤纳入研究,将微血管形态分为三型:Ⅰ型:无微血管形态可见;Ⅱ型:微血管沿腺管开口排列,粗细均匀;Ⅲ型:微血管粗细不均,排列紊乱。同时将病变组织进行CD34、IGF-1、STAT3免疫组织化学染色,比较NBI微血管形态特征和组织学结果的相关性。结果:共有58例患者的64个部位(结肠早期癌15个,腺瘤29个,正常黏膜20个)进行NBI内镜检查,NBIⅡ型部位以腺瘤为主,占82.1%(23/28),而早癌多表现为Ⅲ型,占66.7%(10/15)。免疫组织化学提示微血管密度(MVD-CD34)、IGF-1在正常黏膜、结肠腺瘤和结肠早癌中的表达有显著性差异(P<0.000 1,P=0.006 2),STAT3在三者间表达有逐渐增高的趋势(P=0.071 3)。在NBI微血管形态分型Ⅰ、Ⅱ、Ⅲ型组织中MVD-CD34、IGF-1、STAT3的表达均有显著性差异(P<0.000 1,P=0.001 0,P=0.005 5)。NBI的微血管类型和MVD、IGF-1、STAT3表达的相关系数分别为0.67、0.41和0.40。结论:根据NBI内镜实时微血管形态评估组织血管生成,是一项非常有前景的结肠息肉癌变检测方法。

Objective：To investigate the correlation between the expression of angiogenic factors （MVD, IGF-1, and STAT3） in colorectal carcinoma and adenoma and the microvascular characteristics under narrow band imaging （NBI）, in order to evaluate the fea-sibility of NBI in real-time observation of angiogenesis. Methods：Patients with pathologically confirmed colorectal polyps were re-cruited and examined by NBI. Vascular patterns were classified into typeⅠ（invisible or faintly visible）, typeⅡ（clearly visible and regularly arranged in a round, oval honeycomb-like pattern）, and typeⅢ（clearly visible and irregularly arranged in terms of size and caliber or irregularly winded）. Immunohistochemical staining was performed to determine the expression of CD34, IGF-1, and STAT3. Histological results were compared with the vascular patterns under NBI. Results：The NBI endoscopy results of 64 sites （15 adenocar-cinomas, 29 adenomas, and 20 normal tissues） from 58 patients were introduced and examined in this study. Adenomas ranked the first （82.1%, 23/28） among the vascular patternⅡcases, whereas early adenocarcinomas dominated the vascular patternⅢcases （66.7%, 10/15）. The expression levels of MVD-CD34 and IGF-1 in normal mucosa, adenomas, and adenocarcinomas were significantly differ-ent （P〈0.0001 and P=0.0062, respectively）. All the expression levels of MVD-CD34, IGF-1, and STAT3 in sites displaying vascular pat-ternsⅠ,Ⅱ, andⅢwere significantly different （P〈0.0001, P=0.0010, and P=0.0055, respectively）. Spearman correlation coefficients between the NBI vascular patterns and the MVD-CD34, IGF-1, and STAT3 expression levels were 0.67, 0.41, and 0.40, respectively. Conclusion：Vascular pattern analysis through an NBI system can be a promising tool to evaluate angiogenesis of colorectal lesions in real-time endoscopic observation.