胃癌患者血清和组织中sTNFR-I的临床观察及其意义

Clinical Study on Serum and Tissue Levels of Stner-Ⅰ in Patients with Gastric Cancen and Their Signficance

目的研究胃癌患者血清及组织中可溶性肿瘤坏死因子受体-Ⅰ(sTNFR-Ⅰ)变化的临床意义。方法采用双抗体夹心ELISA法,对66例胃癌患者手术前后、38例胃良性疾病患者(慢性浅表性胃窦炎患者30例,功能性消化不良8例)及40例健康体检者血清sTNFR-Ⅰ水平进行检测;同时检测了胃癌及胃良性疾病者活检组织中sTNFR-Ⅰ的浓度。结果胃癌患者血清sTNFR-Ⅰ为2.36±0.78μg/ml,明显高于胃良性疾病者(0.82±0.28.ng/ml)和健康体检者(0.78±0.27ng/ml),P<0.001。胃癌组织中sTNFR-Ⅰ为2.52±0.86ng/ml,明显高于胃良性疾病胃黏膜组织(0.86±0.33ng/ml),P<0.001。胃癌按Ⅰ-Ⅳ级分期的不同,sTNFR-Ⅰ在血清和组织中逐渐增高,且各期之间进行比较均P<0.01;其中Ⅰ期(12例)、Ⅱ期(14例)、Ⅲ期(25例)术后血清sTNFR-Ⅰ明显下降,与术前相比各自P<0.01;而Ⅳ期患者(15例)手术前后无明显变化且有所增高;手术切除组(53例,根治或姑息切术)术后sTNFR-Ⅰ明显降低(P<0.001),而探查者或胃空肠吻合术者(13例)术后血清sTNFR-Ⅰ反而增高。结论动态观察血清及组织中sTNFR-Ⅰ的变化可作为胃癌的诊断、手术方法选择、疗效评价及预后监测有意义的参考指标。

Objective To study the changes of serum and tissue slouble tumor necrosis factor receptor-Ⅰ ( sTNFR-Ⅰ ) in gastric cancer patients and their clinical significance. Methods Serum level of sTNFR-Ⅰ was defected by the double antibody sandwich ELJSA method in 66 patients with gastric cancer before and after operation, 38 benign disorders (30 cases of superficial antral gastritis, 8 cases of functional dyspepsia) and 40 controls. Simultaneously, tissue level of sTNFR-Ⅰ was measured in the patients of gastric cancer and benign disorders. Resultes (1) The eerum sTNFR-Ⅰ level (2.36±0.78 ng/ml vs0.82 ±0.28 ng/ml and 0.78 ±0.27 ng/ml, P<0.001) in gastric cancer patients was significantly higher than those in the benign disorders and healthy controls; (2) The tissue sTNFR- Ⅰ level in the gastric cancer patients was significantly higher than that in the benign disorders (P<0.001) 5 (3) The serum and tissue level of sTNFR-Ⅰ showed statistical difference among the gastric cancer of Ⅰ , Ⅱ ,Ⅲ,Ⅳstages (one another comparison P<0.01) ; (4) The serum sTNFR-Ⅰ level declined remarkably after gastrectomy in Ⅰ,Ⅱ,Ⅲ, stages of the gastric cancer (P<0.001) , nevertheless in Ⅳ stage of the gastric cancer it was not changed before and after operation; ,(5) The serum level of sTNFR-Ⅰ declined remarkably after operation of radical or pallitive. Conversely, it increased after exploratory laparotomy and gastroenterostomy. Conclusion Dynamic alterations of serum and tissue sTNFR-Ⅰ level may be used as the indicators of diagnosis, the choice of operative method and judgement of prognosis in patients with gastric cancer.