NSCLC患者术后循环血中胰岛素样生长因子Ⅰ水平降低及其临床意义

The level of insulin-like growth factor-Ⅰ in blood circulation in patients with non-small cell lung cancer after surgery and its clinical significance

背景与目的:胰岛素样生长因子Ⅰ(insulin-like growth factor-Ⅰ,IGF-Ⅰ)与多种肿瘤进展有关,但其在肺癌进展中的作用尚未阐明,本研究旨在从检测围手术期循环血中IGF-Ⅰ水平变化这一角度,探讨循环血IGF-Ⅰ在非小细胞肺癌(non-small cell lung cancer,NSCLC)发展中的作用及其临床意义。方法:采用双抗夹心酶联免疫吸附实验(ELISA)定量检测80例原发性NSCLC和45例肺良性疾病患者术前及术后第7天循环血中IGF-Ⅰ的含量,分析围手术期循环血中IGF-Ⅰ水平变化与NSCLC病理特征的关系。结果:循环血中IGF-Ⅰ的水平在肺良性疾病组中,术后显著升高[(12±4)ng/mL比(19±6)ng/mL,P=0.0346];而在NSCLC组中,则是术后降低[(22±9)ng/mL比(18±6)ng/mL,P=0.0030];降低程度在肿瘤直径≥3cm组[(25±8)ng/mL比(15±8)ng/mL,P=0.0051]、伴局部淋巴结转移组[(26±8)ng/mL比(16±7)ng/mL,P=0.0131]、晚期组[(24±9)ng/mL比(19±7)ng/mL,P=0.0092]和低分化组[(22±6)ng/mL比(14±6)ng/mL,P<0.0001]中尤其显著。结论:IGF-Ⅰ可能以自分泌和(或)旁分泌方式在NSCLC恶性进展过程中起重要促进作用。检测循环血中IGF-Ⅰ水平对辅助判断NSCLC恶性程度和分期可能有应用前景。

Background and purpose： Insulin-like growth factor- I （IGF- I ） stimulates the progression of a variety of cancers, but its role in lung cancer progression is not clear. This study was to explore the possible role of circulating IGF- I in the development of non-small cell lung cancer （NSCLC）, based on the changes of the circulating IGF-1 level of peripheral blood. Methods： Preoperative and postoperative （the seventh day after surgery） circulating IGF-I of the peripheral blood in 80 patients with NSCLC and 45 patients with benign pulmonary disease were measured by enzyme linked immunosorbent assay （ELISA） and the relationship between its perioperative alterations and pathological parameters was analyzed. Results： Blood circulating IGF-I level was significantly elevated in patients with benign pulmonary disease after surgery [（12±4）ng/mL vs. （19±6）ng/mL, P=0.034 6], however, its level was significantly decreased after surgery in patients with NSCLC[（22±9）ng/mL vs. （18±6）ng/mL, P=0.003 0], especially in those with either advanced stages （stage Ⅲ and Ⅳ） [（24±9）ng/mL vs. （19±7）ng/mL, P=0.009 2], with a tumor diameter no less than 3 cm [（25±8）ng/mL vs. （15±8）ng/mL, P=-0.005 1 ], with regional lymphoid node metastasis [（26±8）ng/mL vs. （164-7）ng/mL, P=0.013 1] or with poor differentiation [（22±6）ng/mL vs. （14±6）ng/mL, P〈0.000 1]. Conelusion： This study provided clinical evidence for the first time that IGF-I may promote malignant progression of NSCLC in an autocrine and/or paracrine manner. Examination of circulating IGF-I may have clinical value to assess malignancy and stage of NSCLC.