恶性肿瘤外周血微转移检测的临床研究

Clinical research on detecting the micrometastasis in peripheral blood of malignant tumors

目的研究外周血CEA、CK20mRNA表达检测在胃恶性肿瘤转移及预后判断中的作用。方法采用逆转录实时定量PCR(Real-time PCR)法检测52例经病理确诊的胃恶性肿瘤患者,28例胃良性肿瘤患者,29例健康体检对照者外周血及组织标本CEAmRNA、CK20mRNA表达;电化学光免疫测定外周血CEA水平,结果血清CEA在胃良恶性肿瘤中的阳性检出率有显著差异(P<0.05),但在是否有远处转移者中的差异无统计学意义(P>0.05)。胃癌患者外周血可检测到不同水平的CEA及CK20mRNA表达,其中,CEAmRNA的表达与胃癌病理类型及分期相关;而CK20mRNA的表达与分期及有无淋巴结转移相关;两者联合检测较单个指标的检出阳性率高。结论胃癌CEA、CK20表达可能与转移相关;采用实时定量RT-PCR检测外周血中CEA、CK20基因的表达可能为一种较理想的无创性胃癌诊断、转移的检测方法;血清CEA水平不能反映胃恶性肿瘤的转移情况。

Objective To study the effect of the expression of CEA, CEAmRNA, CK20mRNA on detecting the metastasis and prognosis of gastric malignant tumors.Methods There were 52 cases of gastric cancer diagnosed by the pathology,28 eases of gastric benign tumors,29 health vohmteers,applying Real-time reverse transcription PCR （RT-PCR） to detect the expression of CEAmRNA, CK20mRNA in peripheral blood and in tissue,and electrochemilumineseent immunoassay to detect CEA in peripheral bloed. Results There was the significant difference on the positive rate of serum CEA between the benign and malignant tumors（ P 〈 0.05）,but no significant difference between the gastric eaneer patients with distant metastasis by serum and without metastasis（ P 〉 0.05）. The different levels of CEAmRNA,CK20mRNA were detected in peripheral blood of the gastric cancer patients. The expression of CEAmRNA was correlated with clinical stage and pathological types of gastric cancer. The expression of CK20mRNA was correlated with clinical stage and lymph nodes metastasis. The positive rate of allied detection of CEAmRNA,CK20mRNA was higher than the single detection. Conclusion It is possible that the expression of CEAmRNA, CK20mRNA is associated with metastasis. The expression of CEAmRNA,CK20mRNA in peripheral blood detected by Real-time reverse transcription PCR （RT-PCR） is perhaps an ideal method for nontraumatic diagnosis of gastric cancer or its metastasis. The level of serum CEA can not reflect the metastasis of tumors.