瘤体内注射糖皮质激素对婴幼儿血管瘤组织中血管内皮生长因子表达的影响

目的探讨糖皮质激素瘤体内注射对婴幼儿增生期血管瘤组织中血管内皮生长因子(VEGF)表达的影响及意义。方法选取拟手术治疗的增生期血管瘤患儿20例,分别于术前3d、6d、9d、2周注射曲安奈德1次(1mg/cm2),各5例;对照组为消退期血管瘤5例和增生期血管瘤5例,均不予用药。手术切除后瘤体标本,立即予40g/L甲醛固定,常规石蜡包埋,切片,HE染色,光镜下观察组织学变化,采用兔抗人VEGF多克隆抗体,第2代通用型二步免疫组织化学法染色,测定每张图片的平均吸光度(A)值,每张切片随机选取5个高倍镜视野。结果HE染色切片光镜下观察,各用药组与未用药组组织学比较均无显著性差异。免疫组织化学染色切片见VEGF表达在增生期血管瘤组织已出现血管腔的内皮细胞胞质中和尚未出现血管腔的内皮细胞胞质或胞膜中,在增生期未用药组中可见棕褐色颗粒,呈强阳性表达,随着激素影响时间的延长,1周后其表达强度渐下降,染色深度渐变浅,阳性细胞渐减少。测定其免疫反应阳性颗粒积分A值,未用药组与术前6d、9d、2周和消退期血管瘤组行样本均数的两两比较有统计学差异(F=17.9191P<0.01),糖皮质激素影响时间和血管瘤VEGF的表达呈显著负相关(r=-0.5922P<0.01)。结论应用曲安奈德瘤体内注射治疗婴幼儿增生期血管瘤,能明显下调VEGF表达,促进血管瘤消退。

Influence of Intralesional Glucocorticoid on the Expression of Vascular Endothelial Growth Factor in Hemangioma Tissues

ObjectiveTo explore the clinical effectiveness of intralesional glucocorticoid therapy on infantile hemangioma in proliferative stage,and variance of vascular endothelial growth factor(VEGF) expression in the hemangioma tissues.MethodsExperimental group:5 cases were injected with triamcinolone acetonide 3 days before operation,5 cases were done 6 days before operation,5 cases were done 9 days before operation and 5 cases were done 2 weeks before operation(the dose of injection was 1 mg/cm2 per time,but not exceeding 2 mg/kg).Control group:5 infantile hemangioma cases in involuting stage and 5 infantile hemangioma cases in proliferative stage did not received any therapy.The specimen of the hemangioma were collected to detect the expression of VEGF by two-step immunohistochemistry.Every optical slice was detected by 5 campus visualis of high power lens.ResultsObserving the specimen dyed by HE in the light microscope,there was no significant difference between injected group and non-injected group.But by means of immunohistochemistry,the expression of VEGF could been down regulation by the glucocorticoid(F=17.919 1P<0.01),the relationship of affection time of the glucocorticoid and the expression of the VEGF was obviously negative correlation(r=-0.592 2P<0.01).ConclusionsIntralesional corticosteroid therapy on infantile hemangioma is able to greatly decrease the expression of VEGF and to promote involution of infantile hemangioma.