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目的探讨肝细胞癌(HCC)的螺旋CT征象与瘤内微血管密度(MVD)及血管内皮生长因子(VEGF)表达之间的关系。资料与方法运用免疫组织化学SP法,检测45例经手术切除并病理证实的HCC瘤内MVD及VEGF的表达,所有病例术前均行CT平扫及增强扫描。结果CT征象与MVD、VEGF表达之间的关系:(1)瘤体边缘模糊组和清晰组的HCCMVD分别为50.3±16.2和38.7±13.4,VEGF阳性表达率分别为90.0%(19/21)和54.1%(13/24),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(2)瘤内有坏死不强化组和无坏死组的HCCMVD分别为65.3±17.6和38.2±13.0,VEGF阳性表达率分别为77.8%(7/9)和69.4%(25/36),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(3)有扩散转移组和无扩散转移组的HCCMVD分别为73.9±20.4和40.6±17.1,VEGF阳性表达率分别为100.0%(18/18)和51.8%(14/27),组间MVD及VEGF阳性表达率均有显著性差异(P<0.01)。(4)瘤体直径>5cm和直径≤5cm的HCCMVD分别为54.6±18.4和46.1±16.5,VEGF阳性表达率分别为75.0%(15/20)和68.0%(17/25),组间MVD及VEGF阳性表达率均无显著性差异(P>0.05)。(5)动脉供血型、双重供血型及少供血型HCC的MVD分别为70.6±22.9、65.7±21.6和25.1±13.5,VEGF阳性表达率分别为85.1%(23/27)、63.6%(7/11)和28.6%(2/7)。动脉供血型和双重供血型、双重供血型和少供血型之间VEGF阳性表达率差异均无显著性(P>0.05),动脉供血型或动脉供血型和双重供血型合并组与少供血型之间VEGF阳性表达率差异有显著性(P<0.05);动脉供血型和双重供血型的HCC,其MVD计数均高于少血供型,组间有显著性差异(P<0.01),动脉供血型与双重供血型MVD计数无显著性差异(P>0.1)。结论MVD及VEGF表达与HCC的边缘是否清晰、瘤内有无液化坏死、有无浸润转移及增强类型等CT征象密切相关,反映了新生血管是其生长、发展的形态学基础,在HCC的浸润转移中起重要作用。
Objective To investigate the relationship between spiral CT features of hepatocellular carcinoma (HCC) and intratumoral microvessel density (MVD) and expression of vascular endothelial growth factor (VEGF). Materials and Methods Immunohistochemical SP method was used to detect the expression of MVD and VEGF in 45 cases of HCC tumors that were surgically resected and pathologically diagnosed. All the cases underwent CT plain scan and enhanced scan before surgery. Results The relationship between CT signs and MVD and VEGF expression: (1) The HCCMVD of the fuzzy group and the clear group were 50.3±16.2 and 38.7±13.4, respectively. The positive expression rate of VEGF was 90.0% (19/21). 54.1% (13/24), the positive expression rate of MVD and VEGF among the groups were significantly different (P<0.01). (2) The HCCMVD in necrotic non-enhanced and non-necrotic groups was 65.3±17.6 and 38.2±13.0, respectively. The positive expression rates of VEGF were 77.8% (7/9) and 69.4% (25/36), respectively. The positive expression rates of MVD and VEGF were significantly different (P<0.01). (3) The HCCMVD of the metastatic group and non-diffusion group were 73.9±20.4 and 40.6±17.1, respectively. The positive expression rates of VEGF were 100.0% (18/18) and 51.8% (14/27) respectively. The positive expression rate of VEGF was significantly different (P<0.01). (4) The HCCMVD with tumor diameter >5cm and diameter ≤5cm were 54.6±18.4 and 46.1±16.5, respectively. The positive expression rates of VEGF were 75.0% (15/20) and 68.0% (17/25), respectively. There was no significant difference in the positive expression rate of VEGF (P>0.05). (5) The MVD of arterial blood supply, dual blood supply and less blood supply HCC were 70.6±22.9, 65.7±21.6 and 25.1±13.5, respectively. The positive expression rates of VEGF were 85.1% (23/27) and 63.6% (7/ 11) and 28.6% (2/7). There was no significant difference in the positive expression rate of VEGF between arterial blood supply and dual blood supply, dual blood supply and less blood supply (P>0.05). The arterial blood supply type or arterial blood supply type and dual blood supply type combined group and less blood supply type were not different. There was a significant difference in the positive expression rate of VEGF between the two groups (P<0.05). The arterial blood supply and dual blood supply of HCC showed higher MVD counts than those of less blood supply groups. There was a significant difference between groups (P<0.01). There was no significant difference in MVD count between blood type and dual blood supply type (P>0.1). Conclusions The expression of MVD and VEGF is closely related to CT signs such as whether the edge of HCC is clear, whether there is liquefaction and necrosis in the tumor, whether there is infiltration and metastasis, and enhancement type. It reflects that the neovascularization is the morphological basis of its growth and development, infiltration of HCC. Transfer plays an important role.