胃癌内镜超声分期与MMP-9基因表达的关系

Relationship between preoperative staging of endoscopic ultrasonography and genic expression of MMP-9 in gastric carcinoma

目的探讨内镜超声(EUS)对胃癌的术前分期及其与肿瘤转移相关基因表达的关系。方法63例胃癌患者术前行胃镜和EUS检查并进行术前分期,同时运用ELISA法检测术前MMP-9血清水平,应用免疫组织化学技术和原位杂交技术检测胃癌组织中MMP-9蛋白的表达并与术后病理分期比较。结果EUS对胃癌侵犯深度判断的总准确率为80.95%,对淋巴结转移的总准确率为73.02%。胃癌患者血清MMP-9水平与组织中MMP-9蛋白及MMP-9 mRNA表达呈一致性。MMP-9表达水平与胃癌组织浸润程度、EUS分期、淋巴结转移关系密切(P<0.05)。联合EUS和MMP-9对胃癌侵犯深度判断的准确率明显提高,其总准确率为95.22%。结论①EUS对胃癌的分期具有其分子生物学改变的基础。②胃癌患者术前血清MMP-9水平对EUS术前分期有参考价值,若显著增高者,术前EUS检查时,应注意癌肿是否已达或超过浆膜层。③EUS联合术前检测MMP-9血清水平,有利于提高对胃癌浸润转移判断的准确性。

Objective To investigate the relationship between the staging of endoscopic ultrasonography（EUS） and the expression of carcinoma metastasis associated genic in the patients with gastric carcinoma, Methods Sixty-three patients with gastric cancer were diagnosed by electric gastroscopy and EUS. The preoperative staging of gastric cancer was measured by EUS and compared by pathologic staging and MMP-9 expression. MMP-9 level of peripheral serum was measured by enzyme-linked immunosorbent assay, while the expression of MMP-9 protein was tested by immunohistochemistry and hybridization in situ in the gastric carcinoma tissue, Results The total accuracy rate of EUS in estimating invasive depth of gastric cancer was 80.95%, while that of lymphatic metastasis was 73,02%. The expression level of MMP-9 in serum was consistent with the expression of MMP-9 protein and MMP-9 mRNA in tissue, which was closely correlative with invasive degree, staging with EUS, lymphatic metastasis in gastric cancer （ P 〈 0.05）. The total accuracy rate of estimating invasive depth in gastric cancer was 95.22% by combination of EUS and MMP-9, Conclusions The changes of ultrasonic manifestation have the molecular biologic basis. The MMP-9 level of preoperative serum has the reference value for preoperative staging of EUS in the patients with gastric cancer. When the MMP-9 level in serum of gastric cancer is significantly high, doctors should pay more attention to metastasis wether reach the serosa or beyond. Combining EUS and MMP-9 can increase the accuracy rate to decide the invasion and metastasis in the patients with gastric carcinoma.