1、 1217 2022 年第 24 卷第 12 期(总第 230 期)作者简介张文莉，女，主治医师，研究方向:宫颈癌。E-mail:Z*通讯作者王蕊，女，主治医师，研究方向:妇产科。E-mail:3D-CPA 对宫颈癌的检测结果及与 mi-455、VEGF、MVD 表达的相关性研究张文莉，冯彩霞，王彩丽，许汴菊，李光，王蕊*(榆林市第一医院妇产科，陕西 榆林 719000)摘要 目的:分析三维彩色血管能量成像(3D-CPA)对宫颈癌的检测结果及与宫颈癌患者 mi-455、血管内皮生长因子(VEGF)和病理微血管密度(MVD)表达的相关性。方法:选取我院 2018 年 12 月至 2020 年 1
2、2 月收治的宫颈癌患者 80 例，设为宫颈癌组;选取同期 80 例宫颈上皮内瘤变(CIN)患者设为 CIN 组;选取同期 80 例健康女性作为对照组。比较各组患者的 3D-CPA 检测特征与血管参数测值。应用 3D-CPA 观察各组患者宫颈内部血流，比较各组患者血流分级结果。比较不同血流分级宫颈癌患者 mi-455、VEGF 和 MVD 表达情况，并分析 mi-455、VEGF 和 MVD 表达与宫颈癌患者 3D-CPA 检测结果的相关性。结果:3D-CPA 图像显示，宫颈癌组 80 例患者中有 75 例出现肿块，且血管丰富、走形杂乱，大多数患者肿块内血管出现血管树或血管网状结构;CIN 组
3、80 例宫颈上皮内瘤变患者，经过阴道超声均未发现肿块，宫颈病变局部血流较为丰富，三维成像之后可以看到大多数患者出现棒状或条状血管，无火球状血流;对照组的所有受检女性，阴道超声显示宫颈回声均匀，宫颈内部仅有少量点状血流信号。通过对比血管参数测值发现，三组患者血管化指数(VI)，血流指数(FI)，血管化-血流指数(VFI)比较，差异均有统计学意义(P 0.05)。不同血流分级宫颈癌患者年龄、肿瘤直径、临床分期、组织分化程度比较，差异均无统计学意义(P 0.05);不同血流分级宫颈癌患者淋巴结节转移、MVD、VEGF、mi-455 比较，差异均有统计学意义(P 0.05)。Spearman 相关分析
4、结果显示，宫颈癌患者 3D-CPA VI 值与 mi-455、VEGF 和 MVD 表达正相关(P 0.05)。结论:应用 3D-CPA 能够评估宫颈癌的肿瘤血管生成，对临床宫颈癌的诊断与治疗具有参考价值。通过血管分级验证发现宫颈癌患者3D-CPA VI 值与 mi-455、VEGF 和 MVD 表达具有相关性，能够反映宫颈癌的肿瘤新生血管情况，从而为临床治疗提供参考。关键词 3D-CPA;宫颈癌;检测价值;mi-455;VEGF;MVD 中图分类号 445 1;73 文献标志码 A 文章编号 1009 0959(2022)12 1217 05The Detection esults of 3
5、D-CPA for Cervical Cancer and Correlation withExpression of mi-455，VEGF and MVDZHANG Wenli，FENG Caixia，WANG Caili，XU Bianju，LI Guang，WANG ui*(Department of Obstetrics and Gynecology，the First Hospital of Yulin City，Shaanxi Yulin 719000，China)Abstract Objective:To investigate the detection results of
6、 three-dimensional color power angiography(3D-CPA)for cervical cancerand their correlation with the expression of mi-455，vascular endothelial growth factor(VEGF)and pathological microvascular density(MVD)in patients with cervical cancer.Methods:A total of 80 patients with cervical cancer admitted to
7、 our hospital from December2018 to December 2020 were selected as the cervical cancer group.80 patients with cervical intraepithelial neoplasia(CIN)during thesame period were selected as the CIN group.A total of 80 healthy women were selected as the control group.The 3D-CPA characteristicsand vascul
8、ar parameters of each group were compared.3D-CPA was used to observe the internal cervical blood flow in each group，andthe results of blood flow grading of each group were compared.The expressions of mi-455，VEGF and MVD in cervical cancer patientswith different blood flow grades were compared，and th
9、e correlation between the expressions of mi-455，VEGF and MVD and the resultsof 3D-CPA detection in cervical cancer patients was analyzed.esults:3D-CPA images showed that 75 out of 80 patients in the cervicalcancer group had mass，and the blood vessels were rich and disorganized，and most patients had
10、vascular tree or vascular network struc-ture in the blood vessels inside the mass.No mass was found after transvaginal ultrasound in the 80 patients with cervical intraepithelial ne-1218 2022 Volume 24 No.12(Serial No.230)oplasia in the CIN group，and the local blood flow of cervical lesions was rela
11、tively rich.After 3D imaging，most patients in the CIN groupshowed rods or strips of blood vessels without“fireball”blood flow.In the control group，the vaginal ultrasound showed that the cervicalecho was uniform and there were only a few punctured blood flow signals inside the cervix.The vascularizat
12、ion index(VI)，flow index(FI)and vascularization flow index(VFI)of the three groups were compared，and the differences were statistically significant(P 0.05).There were no statistical differences in age，tumor diameter，clinical stage and tissue differentiation degree among cervical cancerpatients with
13、different blood flow grades(P 0.05).There were statistical differences in lymphonodule metastasis，MVD，VEGF andmi-455 among cervical cancer patients with different blood flow grades(P 0.05).Spearman correlation analysis showed that the 3D-CPA VI results were positively correlated with the expression
14、of mi-455，VEGF and MVD in patients with cervical cancer(P 0.05).Conclusion:The application of 3D-CPA can evaluate tumor angiogenesis of cervical cancer，which has high diagnostic value and has refer-ence value for clinical diagnosis and treatment of cervical cancer.Through vascular grading verificati
15、on，it was found that the results of3D-CPA VI results were correlated with the expression of mi-455，VEGF and MVD in patients with cervical cancer，which could reflectthe tumor neovascularization of cervical cancer，thus providing reference for clinical treatment Key Words 3D-CPA;Cervical cancer;Detecti
16、on value;mi-455;VEGF;MVD宫颈癌是一种常见的妇科恶性肿瘤，其高发年龄为 30 35 岁，而 50 55 岁浸润性宫颈癌的发病率最高1。早期宫颈癌患者治疗效果较好，而且5 年生存率较高，但是晚期宫颈癌患者化疗敏感性差，患者的生存率降低。越来越多的临床研究显示，血管生成对于宫颈癌肿瘤的远处转移、浸润和生长非常重要2，3。临床上常采用病理检测确诊宫颈癌患者，但是病理诊断存在一定局限性，虽然能够判定患者肿瘤的良恶性程度，但是并不能观察到患者宫颈内部肿瘤情况。而超声检查是当前在活体之中无创监测血流的重要方法，易操作、经济性好、快捷，并且能够多次重复检查4。随着临床医学发展，三维彩色血管能量成像(3D-CPA)技术逐渐被应用到宫颈内血流分布分析应用计算中。为了探讨 3D-CPA 对宫颈癌的诊断价值和在评估宫颈癌血管生成方面的价值，本研究选取我院 2018 年 12 月至 2020 年 12 月收治的 80 例宫颈癌患者作为研究对象，探讨 3D-CPA 对宫颈癌的检测价值及其检测结果与宫颈癌患者 mi-455，血管内皮生长因子(VEGF)和病理微血管密度(MVD)表达的相关性。
