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目的观察经导管动脉化疗栓塞(TACE)联合应用血管生成抑制剂内皮抑素(endostatin,ES)对兔VX2肝移植瘤疗效的影响。材料与方法30只兔VX2肝移植瘤模型随机分为对照组、TACE组(碘油+阿霉素)和抗血管生成组(碘油+阿霉素+ES),每组10只。种植后3周行TACE术,术后1周获得病理标本,分别利用免疫组织化学法和原位末端标记法检测所有标本的肿瘤微血管密度(microvascular density,MVD)及残瘤细胞的增殖、凋亡情况,并分析增殖指数(proliferation index,PI)和凋亡指数(apoptosis index,AI);术前、术后行MSCT和超声检查并计算肿瘤增长率(growth rate,GR)。结果三组肿瘤GR(%)分别为270.86±148.94、-8.91±21.77和-20.40±36.07,治疗后TACE组和抗血管生成组肿瘤体积均减小,与对照组比较差异性有统计学意义(P<0.01),各组MVD值分别为80.00±17.14、84.22±16.45、57.00±13.26,抗血管生成组最低,与其余两组比较差异均具有统计学意义(P<0.05),对照组和TACE组两组间差异无统计学意义(P>0.05);各组PI值(%)和AI值(%)分别为52.84±7.37、84.53±5.31、79.98±8.38和3.58±0.066、12.28±0.85、14.39±1.32;PI值对照组最低,与其余两组比较差异有统计学意义(P<0.01),抗血管生成组低于TACE组,但无统计学意义(P>0.05);AI值抗血管生成组最高,各组两两比较差异均具有统计学意义(P<0.01)。结论兔VX2肝移植瘤介入治疗中应用ES可直接减少肿瘤微血管的生成,间接影响肿瘤细胞的增殖和凋亡,两种疗法均可抑制肿瘤的生长,联合治疗效果更好。
Objective To observe the effect of transcatheter arterial chemoembolization (TACE) combined with angiogenesis inhibitor endostatin (ES) on the efficacy of transplanted VX2 liver tumor in rabbits. Materials and Methods Thirty rabbits were randomly divided into control group, TACE group (lipiodol plus doxorubicin) and anti-angiogenic group (lipiodol plus doxorubicin + ES). TACE was performed 3 weeks after implantation and pathological specimens were obtained one week after operation. The tumor microvessel density (MVD) and the proliferation and apoptosis of the tumor cells were detected by immunohistochemistry and in situ end-labeling, respectively The proliferation index (PI) and apoptosis index (AI) were analyzed. MSCT and ultrasonography were performed preoperatively and postoperatively to calculate the growth rate (GR). Results The tumor GR (%) of the three groups were 270.86 ± 148.94, -8.91 ± 21.77 and -20.40 ± 36.07, respectively. The tumor volume of TACE group and antiangiogenic group decreased after treatment, which was statistically significant compared with the control group (P <0.01). The MVD of each group was 80.00 ± 17.14,84.22 ± 16.45 and 57.00 ± 13.26, respectively, which was the lowest in antiangiogenic group (P <0.05). The difference between the two groups was statistically significant (P <0.05) There was no significant difference between the two groups (P> 0.05). The PI value and the AI value were 52.84 ± 7.37, 84.53 ± 5.31, 79.98 ± 8.38 and 3.58 ± 0.066, 12.28 ± 0.85, 14.39 ± 1.32, PI was the lowest in the control group, and the difference was statistically significant compared with the other two groups (P <0.01). The anti-angiogenic group was lower than the TACE group, but not statistically significant (P> 0.05) The highest group was generated, and the difference between groups was statistically significant (P <0.01). Conclusion The application of ES in rabbit VX2 transplanted tumor can directly reduce the formation of tumor microvessels and indirectly affect the proliferation and apoptosis of tumor cells. Both of the two therapies can inhibit the growth of tumor, and the combination therapy is better.