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目的 本实验旨在通过不同类型的小儿颅内肿瘤中多药耐药相关因素的表达情况分析 ,探讨小儿颅内肿瘤化疗疗效较差的原因以及血脑、血肿瘤屏障与颅内肿瘤耐药性的关系 ,以寻求克服这些耐药因素的策略 ,提高颅内肿瘤化疗疗效。方法 标本选自重庆医科大学附属儿童医院及附属第一医院近 3年存档的小儿颅内肿瘤标本共 5 2例 ,星形细胞瘤 8例 ,分化不良的星形细胞瘤 8例 ,多形性胶质母细胞瘤 8例、脑膜瘤 8例、髓母细胞瘤 10例和颅咽管瘤 10例 ,此外还作了 5例正常脑组织作对照。所有患儿均为初诊 ,年龄 1～ 18岁 ,中位年龄 5岁 ,男∶女 =2∶1。 2 9例获随访资料 ,随访时间 2个月～ 3年 ,术后生存期自手术日至失访或死亡日止。应用SP免疫组化方法检测小儿颅内肿瘤中P gp、MRP、LRP、TopoIIα的表达。 结果 在所有检测的颅内肿瘤中P gp、MRP、LRP、TopoIIα的表达阳性率分别是 6 1.5 %、36 .5 %、2 6 .9%、36 .5 %。P gp、MRP、LRP在星形细胞瘤和髓母细胞瘤中主要表达于血管内皮细胞 ,而肿瘤细胞几乎不表达。但在脑膜瘤、颅咽管瘤中却没有这种差异。TopoIIα主要表达于肿瘤细胞核内 ,偶见其他细胞的散在弱阳性表达。 结论 小儿颅内肿瘤化疗失败的原因主要与血脑、血肿瘤屏障对化疗药物的阻滞以及肿瘤细胞本?
Objective This experiment aims to analyze the expression of MDR-related factors in different types of pediatric intracranial tumors to explore the reasons for poor efficacy of chemotherapy in children with intracranial tumors and the relationship between blood brain and blood tumor barrier and intracranial tumor drug resistance In order to seek to overcome these resistance factors strategy to improve the efficacy of intracranial tumor chemotherapy. Methods Specimens were selected from 52 cases of pediatric intracranial tumors, 8 cases of astrocytoma, 8 cases of poorly differentiated astrocytomas, 8 cases of pleomorphic Glioblastoma in 8 cases, meningioma in 8 cases, medulloblastoma in 10 cases and craniopharyngioma in 10 cases, in addition to made 5 cases of normal brain tissue as a control. All children were newly diagnosed, aged 1 to 18 years old, the median age of 5 years old, male: female = 2: 1. Fourteen patients were followed up for 2 months to 3 years. Survival period was from the date of operation to the date of losing or death. SP immunohistochemical method was used to detect the expression of P gp, MRP, LRP and TopoIIα in children with intracranial tumors. Results The positive rates of Pgp, MRP, LRP and TopoIIα in all the detected intracranial tumors were 6 1.5%, 36.5%, 26.9% and 36.5% respectively. P gp, MRP, LRP are mainly expressed in vascular endothelial cells in astrocytoma and medulloblastoma, whereas tumor cells are scarcely expressed. However, in meningiomas, craniopharyngiomas do not have this difference. TopoIIα is mainly expressed in the nucleus of the tumor cells, occasionally scattered weakly positive expression of other cells. Conclusion The main reasons for the failure of chemotherapy in pediatric intracranial tumors are mainly the blockade of chemotherapeutic drugs on blood brain and blood tumor barrier,