目的 探讨前列腺癌骨转移经直肠超声造影参数与ki67表达的相关性。方法 选取临床确诊的93例前列腺癌患者,均行经直肠超声、超声造影及超声引导下前列腺穿刺活检病理证实,检测ki67蛋白免疫组化表达情况,据病理及骨扫描检查结果分为前列腺癌非骨转移(NBM)组及骨转移(BM)组,比较两组经直肠超声造影参数、病理Gleason分级与ki67表达的相关性。结果 93例患者中前列腺癌非骨转移57例,骨转移36例；免疫组化结果： ki67阴性、弱阳性、阳性及以上表达两组比较有差别(P<0.001),BM组ki67阳性及以上表达人数高于NBM组(P<0.05)；BM组造影参数PI、AUC高于NBM组,IHT低于NBM组(P<0.05)；参数PI、AUC与ki67表达呈正相关(r=0.615,P<0.001、r=0.776,P<0.001)；随着Gleason评分等级增加,骨转移人数占比上升,63.9%(23/36)集中于病理分级4~5级,而68.4 %(39/57)的NBM集中于1~ 3级(P<0.001)；且ki67阳性及以上表达患者人数随病理分级的增加占比明显上升,94.5%(19/21)集中于4~5级,(P<0.001),病理分级与ki67表达呈正相关(r=0.638,P<0.001)。结论 前列腺经直肠超声造影参数结合ki67表达能够反映前列腺癌的细胞增殖能力及侵袭性,为前列腺癌骨转移的诊断、治疗及预后评估提供更多有价值的信息。

Objective To investigate the correlation between transrectal ultrasound contrast parameters and expression of ki67 in prostate cancer bone metastases. Methods Ninety-three clinically diagnosed patients with prostate cancer were selected and confirmed by pathological examination of prostate biopsy under rectal ultrasound, ultrasound contrast and ultrasound guidance. The immunohistochemical expression of ki67 protein was detected. According to the pathology and bone scan results, it was divided into non-bone prostate cancer In the metastasis (NBM) group and bone metastasis (BM) group, the correlation between transrectal ultrasound contrast parameters, pathological Gleason grade and ki67 expression was compared between the two groups. Results Among 93 patients, there were 57 cases of non-bone metastasis of prostate cancer and 36 cases of bone metastasis; immunohistochemical results: ki67 negative, weak positive, positive and above expressions were different between the two groups (P<0.001), ki67 positive and above in the BM group The number of expressions was higher than that in the NBM group (P<0.05); the imaging parameters PI and AUC in the BM group were higher than those in the NBM group, and the IHT was lower than the NBM group (P<0.05); the parameters PI and AUC were positively correlated with the expression of ki67 (r=0.615, P <0.001, r=0.776, P<0.001); with the increase of Gleason score level, the proportion of bone metastases increased, 63.9% (23/36) concentrated on pathological grade 4-5, and 68.4% (39/57) Of NBMs were concentrated in grades 1 to 3 (P<0.001); and the number of patients with ki67 positive expression and above increased significantly with the increase of pathological grade, 94.5% (19/21) concentrated in grades 4 to 5, (P<0.001 ), the pathological grade was positively correlated with the expression of ki67 (r=0.638, P<0.001). Conclusion The transrectal ultrasound contrast parameters of prostate combined with ki67 expression can reflect the cell proliferation ability and invasiveness of prostate cancer, and provide more valuable information for the diagnosis, treatment and prognosis evaluation of prostate cancer bone metastasis.

内蒙古自治区自然科学(No.2015MS08141)