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目的 探讨幕上星形细胞瘤的细胞凋亡以及p5 3、bcl 2在凋亡中的意义。方法 免疫组化TUNEL法检测细胞凋亡 ,SP法检测p5 3、bcl 2 ,实验数据由SPSS软件包分析处理。结果 细胞凋亡指数 (AI)随着肿瘤级别的增高而增加 ,各级别肿瘤间AI的差异均有显著性意义 (P <0 0 1) ;死亡组与存活组的AI的差异有显著性意义 (P <0 0 1) ,AI>0 5 %组与AI <0 5 %组的术后 1年生存率的差异有显著性意义 (P <0 0 5 ) ;AI/MI (分裂指数 )在高、低级别的星形细胞瘤中的差异有显著性意义 (P <0 0 5 )。p5 3阳性组与p5 3阴性组的AI、MI术后 1年生存率的差异均有显著性意义 (均P<0 0 5 )。bcl 2阳性组与阴性组的AI、MI、预后均无统计学意义 (均 P >0 0 5 )。多因素logistic回归分析年龄分组、AI、AI/MI、放疗均与预后优劣相关。结论 AI可以作为提示预后的指标 ,并对判断幕上星形细胞瘤的生物学行为及肿瘤分级有指导意义 ;AI/MI值越小 ,肿瘤的恶性转化能力越强 ,预后越差 ;p5 3过度表达提示肿瘤恶性程度高、预后差 ;AI <0 5 %、AI/MI值大的、年龄较轻的、术后放疗病人预后较好。
Objective To investigate the apoptosis of supratentorial astrocytoma and the significance of p53 and bcl2 in apoptosis. Methods Immunohistochemical TUNEL method was used to detect apoptosis. SP5 and bcl2 were detected by SP method. The experimental data were analyzed by SPSS package. Results Apoptosis index (AI) increased with the increase of tumor grade, and there was significant difference in AI among all grades (P <0.01). There was significant difference in AI between death group and survival group (P <0.01). There was a significant difference in 1-year survival rate between AI group (0%) and AI group (P0.05) There was a significant difference in high grade and low grade astrocytoma (P <0.05). There were significant differences in 1-year survival rates between AI3 and PI3-negative patients after AI and MI (all P <0.05). There was no significant difference in AI, MI and prognosis between bcl 2 positive and negative groups (all P> 0.05). Multivariate logistic regression analysis of age group, AI, AI / MI, radiotherapy and prognosis are related. Conclusions AI can be used as an index to predict the prognosis and to guide the prognosis of supratentorial astrocytoma. The smaller the AI / MI value is, the stronger the malignant transformation ability of the tumor is and the poorer the prognosis is. P5 3 Overexpression of malignant tumor showed high, poor prognosis; AI <0 5%, AI / MI large, younger, postoperative radiotherapy patients with better prognosis.