肾癌血管多普勒超声检测与病理免疫组化对比研究

Comparative Study on Renal Carcinoma Vascularity with Color Doppler Ultrasonography and Pathologic Immunohistochemistry

目的 探讨肾癌彩色多普勒血流显像 (CDFI)和脉冲多普勒 (PW )表现特征及其病理学基础 ,评价其临床应用价值。方法 对 3 6例肾癌 ( 2 4例肾透明细胞癌 ,11例肾腺癌 ,1例肾间变癌 )进行CDFI、PW检查 ,术后肿瘤组织标本行免疫组织化学染色 ,抗体分别应用抗CD10 5和抗α 平滑肌肌动蛋白 (α SMA )单克隆抗体 ,计测微血管密度 (MVD)和动脉分数(AF) ,超声检测结果与病理免疫组化结果对比。结果 肾癌血供丰富 ,瘤周多弧形血流 ,瘤内多纡曲网状血流 ,整体呈高速低阻状态 ,瘤周阻力指数 (RI)高于瘤内阻力指数。免疫组化显示肾癌微血管中肌性血管居多 ,AF为 0 .5 9± 0 .0 9,微血管形态及密度差异较大 ,但其表现与RI一致。结论 CDFI、PW检测肾癌血供呈高速低阻状态 ,瘤周RI高于瘤内RI ,此为诊断肾癌的主要参考指标。免疫组化染色显示的肾癌微血管形态及分布特点是其高速低阻血供的病理学基础。

Objective To evaluate the characteristics of color Doppler flow imaging (CDFI), pulsed wave Doppler (PW) and their vascular pathologic basis in renal carcinoma as well as their clinical values. Methods CDFI and PW were performed in 36 renal carcinomas (24 clear cell carcinomas, 11 adenomatosa carcinomas and 1 undiffentiated carcinoma). Immunohistochemistry was done with anti-CD105 and anti-α-smooth muscle actin (SMA) monoclonal antibody after operation. The microvessel density (MVD) of anti-CD105 (MVD CD105) and that of anti-α-SMA (MVD α-SMA) were counted separately and AF was calculated. Comparative study was done between the results of ultrasonography and those of immunohistochemistry. Results The blood supply of renal carcinoma was abundant with the winding blood flows in tumor margin and the torturous ones in center. The whole hemodynamics of renal carcinoma was high peak systolic velocity (PSV) and low resistance index(RI). RI of peritumor was higher than that of intratumor. Immunohistochemistry showed that muscular arteries accounted for the majority of the tumor vessels, AF value was 0.59±0.09. The morphologies and distributions of microvessels in renal carcinomas varied. And the difference of MVD was also significant. All the changes of immunohistochemistry were also in accord with RI. These were the pathologic basis of hemodynamics of renal carcinoma. Conclusion The blood supply detected by CDFI, PW was the chief parameters in diagnosing renal carcinoma. The morphologies and distributions of microvessels showed by immunohistochemistry was the pathologic basis of high PSV and low RI.