血管内皮生长因子、细胞周期相关核抗原Ki-67抗体和p53表达水平与脑膜瘤术后瘤周水肿的相关性研究

The relationship between VEGF,Ki-67 antibody,p53,and PTBE and postoperative peritumoral edema of meningioma

目的探讨血管内皮生长因子(Vascular endothelial growth factor, VEGF)、细胞周期相关核抗原Ki-67抗体和p53的表达水平对脑膜瘤术后瘤周水肿(Pedtumoral brain edema, PTBE)的影响。方法选取2007年1月-2016年7月于本院就诊的脑膜瘤手术患者159例,采用免疫组化检测VEGF,Ki-67抗体和p53在159例脑膜瘤患者中的表达,应用磁共振成像(Magnetic resonance imaging, MRI)检查确定PTBE程度,其中术后无脑膜瘤瘤周水肿70例,术后有脑膜瘤瘤周水肿89例,比较无水肿(no Edema)组和水肿(Edema)组患者的基线资料、VEGF,Ki-67抗体和p53水平的差异,分析三者与脑膜瘤术后瘤周水肿的关系以及对预后的影响。结果 PTBE与患者性别、年龄、BMI、高血压病、糖尿病和术前癫痫无关;与术前瘤周水肿、肿瘤部位、肿瘤直径(cm)、肿瘤形状、肿瘤边界、肿瘤分型、Simpson分级、世界卫生组织(World health organization, WHO)分级、VEGF,Ki-67抗体和p53表达水平有密切关系(P<0.05);其中,近窦型脑膜瘤、肿瘤直径≥5 cm、蘑菇状脑膜瘤、肿瘤边界不清、内皮型脑膜瘤、Simpson分级、WHO分级以及VEGF,p53和Ki-67抗体高表达均为影响PTBE预后的关键风险因素,术前瘤周水肿是保护因素(P<0.05);随着PTBE的病情严重程度增加,VEGF,p53和Ki-67抗体的表达均显著上调(P<0.05);在PTBE发生发展中三者均高表达且互为显著正相关;VEGF,p53和Ki-67抗体阳性患者的3年生存率均显著低于阴性患者(P<0.05)。结论脑膜瘤术后PTBE与一般临床特征、手术切除及肿瘤特征等有关外,与VEGF,Ki-67抗体和p53表达水平也有密切联系。VEGF、Ki-67抗体和p53在脑膜瘤术后瘤周水肿区均高表达且互为显著正相关,可能是导致患者预后不良的关键风险因素。

Objective To investigate the effects of vascular endothelial growth factor(VEGF), cell cycle-associated nuclear antigen Ki-67 antibody, and p53 expression on peritumoral edema(PTBE) after meningioma surgery. Methods A total of 159 cases with meningioma from January 2007 to July 2016 were enrolled in this hospital. The expression of VEGF, Ki-67, and p53 were detected by immunohistochemistry. The degree of PTBE was detected by MRI. The baseline data and the levels of VEGF, Ki-67 antibody and p53 in no Edema group without obvious edema were compared with those in the edema group with significant edema. Results PTBE was not related to sex, age, BMI, hypertension, diabetes, and preoperative epilepsy, but was closely related to preoperative peritumoral edema, tumor location, tumor diameter, tumor shape, tumor boundary, tumor classification, Simpson level, WHO grade, VEGF, Ki-67 antibody and p53. Among them, proximal sinus meningioma, tumor diameter ≥ 5 cm, mushroom meningioma, unclear tumor boundary, endothelial meningioma, Simpson grade, WHO grade and high expression of VEGF, p53 and Ki-67 antibody were all risk factors affecting the prognosis of PTBE. Preoperative peritumoral edema was a protective factor(P<0.05). The expressions of VEGF, p53 and Ki-67 antibody were significantly up-regulated with the severity of PTBE(P<0.05). The 3-year survival rate of VEGF-, p53-and Ki-67 antibody-positive patients was significantly lower than that of VEGF-, p53-and Ki-67 antibody negative patients(p<0.05). Conclusion The occurrence of peritumoral edema after meningioma is not only related to general clinical features and tumor features, but also closely related to the expression of VEGF, Ki-67 antibody and p53. VEGF, Ki-67 antibody and p53 are highly expressed in peritumoral edema after meningioma operation and positively correlated with each other, which are the key risk factors for poor prognosis.