中文摘要：

目的 探讨Ⅳ型胶原和基质金属蛋白酶-2（MMP2）、MMP9在胆囊癌血管生成拟态（VM）中的表达与意义。方法 74例胆囊癌、胆囊腺瘤和慢性胆囊炎各10例病理标本及资料，应用免疫组织化学Envision、SABC法测定上述病变组织Ⅳ型胶原和MMP2、MMP9表达，Kaplan-Meier生存曲线和Cox风险模型分析其与胆囊癌VM的相关性和临床意义。结果 （1）在VM（＋）胆囊癌，Ⅳ型胶原表达明显低于、MMP2表达明显高于VM（-）胆囊癌（P〉0．01），MMP9则无差异。（2）Ⅳ型胶原与VM（＋）胆囊癌分化程度负相关；MMP2、MMP9与VM（＋）胆囊癌的Nevin晚期、侵犯浆膜、肝转移正相关，MMP2尚与VM（＋）胆囊癌的低分化和淋巴结转移正相关。（3）Ⅳ型胶原阳性和MMP2、MMP9阴性VM（＋）胆囊癌患者术后5年生存期明显短于VM（-）胆囊癌（P〈0．01；P〈0．05；P〈0．01），MMP2阳性VM（＋）胆囊癌患者术后5年生存期亦明显短于VM（-）胆囊癌。VM、1V型胶原是影响胆囊癌患者预后的独立因素。结论Ⅳ型胶原、MMP2分别与胆囊癌VM呈负、正相关，MMP9与胆囊癌VM无关；Ⅳ型胶原和MMP2可作为判断胆囊癌是否存在VM及VM胆囊癌预后的重要指标。

英文摘要：

Objective To investigate the expression of collagen Ⅳ and matrix metalloproteinase- 2 （MMP2） ,-9（MMP9） in human primary gallbladder carcinomas with vasculogenic mimicry （VM） and its significance. Methods Seventy-four carcinomas, 10 adenomas and 10 chronic inflammatory lesions of the gallbladder confirmed histopathologically and their clinical-pathlogical data were studied and followedup. Envision method and streptavidin-biotin complex method of immunohistochemistry were used to determine the expression of collagen Ⅳ, MMP2 and MMP9 proteins in each paraffin section of every patient in vivo. Kaplan-Meier actuarial survival curves and Cox multiple factors were used to analyze the correlation among the expression of collagen Ⅳ ,MMP2 and MMP9 proteins and the gallbladder carcinomas with VM, and clinical significance. Results （ 1 ） Expression of collagen Ⅳ in the gallbladder carcinomas with VM was decreased significantly than that of the gallbladder carcinomas without VM （P 〉 0.01 ）. Moreover,expression of MMP2 in the gallbladder carcinomas with VM was increased significantly than that without VM （P 〉 0.01 ） ,without difference on expression of MMP-9 between the gallbladder carcinomas with VM and those without VM. （2）There is negative correlation between expression of collagen Ⅳ and the gallbladder carcinomas with VM in the cases of differentiation degree ; The positive correlation was observed between expression of MMP2 or MMP9 and the gallbladder carcinomas with VM in the cases of Nevin stage,inva- sion depth and liver metastasis, with positive correlation between expression of MMP2 and the gallbladder carcinomas with VM in the cases of differentiation degree and lymph node metastases. （ 3 ） The non-VM group with positive expression of collagen Ⅳ, negative expression of MMP2 and MMP9 had more longer 5- year survival rates than the respectively VM group （P 〈0.01 ,P 〈0.05 ） ; The VM group with negative expression of MMP2 had lower 5-year survival rate than the non