【作者】 徐钰；

【导师】 雷霆；

【作者基本信息】 华中科技大学 ， 外科学， 2011， 博士

【摘要】 目的：分组研究术前不同给药对垂体瘤肿瘤增殖指标Mib-1和TopoⅡα的影响状况,探讨其对肢端肥大症最佳治疗手段的指导意义。方法：收集Nurnberg-Erlangen大学附属神经外科医院2002-2010年确诊的肢端肥大症患者共362例,应用免疫组化染色法显示肿瘤细胞表达Mib-1和TopoⅡα并统计标记指数,收集其余临床资料并加以统计。结果：Mib-1和TopoⅡα的标记指数与肿瘤Hardy分级和肿瘤侵袭性具有显著相关(P=0.000<0.05),肿瘤全切率只与Mib-1标记指数有显著相关性(P=0.000<0.05),两种标记指数并无性别差异(P=0.415和0.861)。不同的术前治疗手段对Mib-1和TopoⅡα的标记指数具有显著影响(P=0.000和0.001),其中生长抑素类似物治疗可以有效降低肿瘤增殖指标指数(P值均为0.000),生长激素受体拮抗剂与生长抑素类似物合用时对肿瘤增殖指标没有明显影响(P>0.05),多巴胺受体激动剂、多巴胺受体激动剂合用生长抑素类似物以及生长抑素类似物合用生长激素受体拮抗剂对肿瘤增殖指标无明显影响(P值均>0.05)。结论：Mib-1和TopoⅡα标记指数在男女患者中没有显著差异,但高低可作为判断肿瘤侵袭程度和预后的指标。术前给予患者生长抑素类似物有助于降低术后肿瘤的复发和侵袭力,生长激素受体抑制剂有导致肿瘤增殖指标指数增高可能,不适合单独给药,最适合与生长抑素类似物合用。多巴胺受体激动剂对肿瘤增殖指标没有显著影响,适合于同时分泌GH和PRL阳性的垂体腺瘤。放疗可作为手术和药物治疗外的辅助手段。更多还原

【Abstract】 Object:To study the influences of different preoperative treatments on proliferation index of pituitary adenoma tumor (Mib-1 and TopoⅡα) in groups, which would provide instructions for the best treatments of acromegaly.Methods:To collect 362 cases of diagnosed acromegaly during 2002-2010 from Kopfklinik of Nurnberg-Erlangen University. Using immunohistochemical staining method to show the positive tumor cells that express Mib-1 and TopoⅡα, and comprehensive analysis the Labeling indexs with other clinical data statistically.Results:The Labeling indexes of Mib-1 and TopoⅡαare significantly relative to pituitary tumors Hardy classification and invasiveness of tumor(all p=0.000<0.05), and only Mib-1 Labeling index correlated the total resection rate significantly(p=0.000<0.05), both Mib-1 and TopoⅡlabeling indexes have no gender difference (p=0.415,0.861. respectively). Different preoperative drug interventions have significant effects on the labeling indexes of Mib-1 and Topo-2a(p=0.000,0.001, respectively), one of which is Somatostatin analogue (SA), that can effectively reduce the tumor proliferation index(p=0.000). However, Somatostatin analogue contributed not significantly to the tumor proliferation labeling indexes when used along with growth hormone receptor antagonists (p>0.05). Administer of only dopamine agonists, or together with Sandostatin analogue, and administer of Sandostatin analogues together with growth hormone receptor antagonist showed no significant influences on tumor proliferation index(p>0.05).Conclusion:The Labeling indexes of Mib-1 and Topo-2a showed no remarkable differences between male and female patients, but which could be the indicator to estimate tumor invade degree and prognosis. Preoperative administration of Somatostatin analogues helps reducing postoperative recurrence and aggressiveness of tumor. Growth hormone receptor inhibitors may increase the tumor proliferation marks index, which are not suitable for single use but recommended to apply together with STT analogue. Dopamine agonists has no significant influence on tumor proliferation index, but it’s suitable for pituitary adenomas which release GH and also PRL. Radiation therapy can be used as auxiliary method besides surgery and pharmacotherapy.更多还原