2018 年第 8 期 第 13 卷

血管生成拟态和瘦素及血管内皮生长因子在子宫内膜癌患者内膜组织中的表达及其在患者预后判断中的价值

Expressions and prognostic values of vasculogenic mimicry, leptin and vascular endothelial growth factor in endometrial carcinoma

作者：李美艳王菊荣韩新彦呼君瑜魏红芳张易欣宋春丽卢静牛广旭

英文作者：

单位：056008河北省邯郸市中心医院妇一科（李美艳、王菊荣、韩新彦、呼君瑜、张易欣、宋春丽），麻醉科（魏红芳），生殖医学科（卢静），病理科（牛广旭）

英文单位：

关键词：子宫内膜癌；血管生成拟态；瘦素；血管内皮生长因子

英文关键词：

• 摘要：

• 【摘要】目的    探讨血管生成拟态(VM)和瘦素及血管内皮生长因子(VEGF)在子宫内膜癌(EC)患者内膜组织中的表达及其在患者预后判断中的价值。方法    选取2012年1月至2013年11月河北省邯郸市中心医院诊治的345例患者，其中经病理检查诊断为EC并进行了手术治疗者197例（EC组）、子宫内膜不典型增生者85例（不典型增生组）、正常子宫内膜者63例（正常子宫内膜组）。采用CD34-过碘酸-雪夫（PAS）双重染色法检测VM在子宫内膜组织中的表达；免疫组织化学链霉菌抗生物素蛋白-过氧化物酶连结法检测瘦素、VEGF蛋白的表达，用列联系数分析三者的相关关系。VM、瘦素及VEGF蛋白对EC患者预后的影响，采用Kaplan-Meier单因素和Cox风险比例模型多因素分析。结果    EC组VM、瘦素、VEGF蛋白的阳性表达率高于不典型增生组、正常子宫内膜组［39.6%（78/197）比4.7%（4/85）、1.6%（1/63），78.7%（155/197）比32.9%（28/85）、9.5%（6/63），68.0%（134/197）比21.2%（18/85）、4.8%（3/63）］，差异均有统计学意义（均P<0.05）。VM与VEGF表达呈正相关（r=0.286，P=0.001）；瘦素与VEGF表达呈正相关（r=0.649，P<0.001）；VM与瘦素呈正相关（r=0.435，P<0.001）。Kaplan-Meier单因素分析显示，VM、瘦素、VEGF表达阳性患者5年总体生存率分别为66.7%、80.6%和79.1%，低于三者阴性患者的95.8%、97.6%和95.2%(均P<0.01)。Cox模型分析EC患者预后相关各因素显示，组织学分化程度、淋巴结转移、VEGF阳性、手术病理分期、VM阳性是影响EC预后的显著因素（均P<0.05）。结论    VM、瘦素和VEGF在EC患者中的表达具有明显的正向协同效应，联合检测三者可能作为诊断和EC预后判断的参考指标之一。

• Objective    To investigate the expressions of vasculogenic mimicry(VM), leptin and vascular endothelial growth factor(VEGF) in endometrial carcinoma(EC) and to analyze the predictive values for prognosis. Methods    Totally 345 gynecological patients were enrolled from January 2012 to November 2013 in Handan Central Hospital, including 197 cases of EC diagnosed by surgical pathological Results    (EC group), 85 cases of atypical hyperplasia of endometrium(atypical hyperplasia group) and 63 cases without endometrial disease(normal endometrium group). Expression of VM in endometrium was detected by CD34-periodic acid-Schiff(PAS) staining. Expressions of leptin and VEGF were detected by immunohistochemical streptavidin-perosidase method. Relations among expressions of VM, leptin and VEGF were analyzed. Relations of VM, leptin and VEGF with the prognosis of EC were analyzed by Kaplan-Meier single factor analysis and Cox model multiple factors analysis. Results    Positive expression rates of VM, leptin and VEGF in EC group were significantly higher than those in atypical hyperplasia group and normal endometrial group［39.6%（78/197） vs 4.7%（4/85）, 1.6%（1/63）; 78.7%（155/197） vs 32.9%（28/85）, 9.5%（6/63）; 68.0%（134/197） vs 21.2%（18/85）, 4.8%（3/63）］（P<0.05）. VM expression was positively correlated with VEGF expression(r=0.286, P=0.001). Leptin expression was positively correlated with VEGF expression(r=0.649, P=0.000). VM expression was positively correlated with leptin expression(r=0.435, P=0.000). Kaplan-Meier analysis showed that the 5-year overall survival rates of patients with positive expression of VM, leptin and VEGF were respectively 66.7%, 80.6% and 79.1%, which were significantly lower than 95.8%, 97.6% and 95.2% of patients with negative expression(P<0.01). Cox model analysis showed that histological differentiation degree, lymphatic metastasis, surgical pathological grade, positive VEGF expression and positive VM expression were influence factors of EC prognosis(P<0.05). Conclusions    VM, leptin and VEGF show positive synergistic effect in EC patients. Combined detection of VM, leptin and VEGF may be a diagnostic and prognostic indicator of EC.