垂体瘤质地的术前评估和多因素分析

目的对垂体瘤质地进行多因素相关性分析,指导垂体瘤质地的术前评估和手术入路选择。方法连续搜集73例垂体瘤病人的临床、影像及手术资料,术前测定患者MRI T2加权像上的瘤体与白质信号比。依术中所见将肿瘤质地分为两种类型：质地软（50例）、质地硬（23例）。采用天狼猩红染色法检测肿瘤胶原含量,并以免疫组化方法检测不同质地垂体腺瘤中的TGF-β1和TIMP1的表达。结果质地硬与质地软组中：①垂体腺瘤质地与患者的临床特性如性别、大小和肿瘤类型无明显关系,与生长方式有关;②瘤体与白质信号比分别为：1.0684±0.2039和2.20341±0.36075;胶原含量分别为（：29.388±14.772）%、（8±2.475）%,两者差异显著（P〈0.01）,且胶原含量与信号强度比值呈明显负相关（r=-0.787,P〈0.05）;③TGF-β1表达量分别为：0.62±0.23和0.28±0.4,TIMP1表达量分别为0.53±0.15、0.25±0.17,二者表达均与胶原含量呈正相关（r=0.781,r=0.46,P〈0.01）。结论垂体腺瘤质地变硬的显著病理特征是胶原过度沉积,T2加权像上的瘤体与白质信号比与肿瘤功能分类及肿瘤生长方式相结合可以术前预测垂体瘤质地。TGF-β1和TIMP1可能在垂体腺瘤质地变化中起重要作用。

Preoperative evaluation and multiple factors analysis for the consistency of Pituitary adenoma

Objective To conduct multivariate correlation analysis of the consistency of pituitary adenoma so as to guide its preoperative evaluation and chose appropriate surgical approach.Methods Clinical,image and surgical data of 73 patients were collected.The signal ratios of the tumors to white matters in T2 weighted MRI were measured preoperativly.According to the surgical finding,tumor consistency was divided in to two types： the soft（50）cases and the hard（23） cases.Collagen contents within the tumors were detected by the means of Sirius red stain and the expression of TIMP1 and TGF-β1 was detected with Immunohistochemistry.Results ①It is found that the consistency of pituitary adenoma have no significant relationship with the clinical characteristics such as gender,tumor size and tumor types,but have correlation with and their growth way.②The signal ratios of the tumors to white matters in T2 weighted MRI（T2WI/TWSIR） were 1.0684±0.2039 and 20341±0.36075 and Collagencontents within the tumors were（29.388±14.772）% and（8±2.475）% respectively in the hard and soft group.The differencese between two groups are significant（P 〈0.01）.In addition collagen content was negatively correlated to T2WI/TWSIR（r=-0.787,P 〈0.05）.③The expressions of TGF-β1 were 0.62±0.23,0.28±0.4 respectively in the hard and soft group.Similarity,the expressions of TIMP1 were 0.53±0.15 and 0.25±0.17.Both of them were positively correlated with the collagen content（r=0.781,r=0.46,P〈 0.01）.Conclusions The significant pathological feature is collagen deposition in harden adenomas.T2WI/TWSIR of the tumor can be combiened with its functional classification and growth pattern,can be used to would be predict the consistency of adenoma presurgically.TGF-β1 and TIMP1 may play an important role in the formation of consistency of pituitary adenoma.