肿瘤坏死因子β基因多态性与食管癌术后并发急性呼吸窘迫综合征的相关性

Relationship between tumor necrosis factor β gene polymorphism and acute respiratory distress syndrome after operation for esophageal carcinoma

背景与目的:肿瘤坏死因子β(tumor recrosis factor beta,TNFβ)基因多态性影响着肿瘤坏死因子α(tumor recrosis factor alpha,TNFα)的表达水平,并与各种原因引起的急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)预后密切相关。本研究旨在探讨TNFβ基因多态性与食管癌根治术后发生ARDS的易感性及预后的相关性。方法:以2005年1月至2007年6月河北医科大学第四医院重症加强医疗科收治的食管癌根治术后发生ARDS的34例患者为研究对象,以同期食管癌术后未发生ARDS的116例患者为对照,提取全血基因组DNA,应用限制性长度多态性及聚合酶链反应方法检测TNFβ基因多态性。结果:与对照组相比,TNFβ基因型和等位基因分布频率差异无统计学意义(P>0.05)。携带TNFβ基因型1/2的ARDS患者与基因型为1/1、2/2的患者相比,机械通气时间和ICU住院时间更短,差异有统计学意义(P<0.05)。生存组ARDS患者TNFβ基因型1/1、等位基因1的检出率显著低于病死组ARDS患者,携带TNFβ基因型1/1、等位基因1的患者病死的相对危险度分别为16.5、11.2。结论:TNFβ基因多态性可能不是决定食管癌术后ARDS发病的重要遗传因素,而是ARDS发展和预后的影响因素。

Background and Objective. A single nucleotide polymorphism of the tumor necrosis factor β （TNFβ） gene affected the level of tumor necrosis factor α and was associated with prognosis of acute respiratory distress syndrome （ARDS）. This study was to investigate the association between the TNFβ and ARDS after operation for esophageal carcinoma. Methods： Thirtyfour patients with and 116 patients without ARDS after radical resection for thoracotomic esophageal carcinoma were recruited in the Fourth Hospital of Hebei Medical University from January 2005 to June 2007. Peripheral blood samples were collected and DNA extracted. TNFβ genotype was determined by restriction fragment length polymorphism （RPLF）. Results. There was no significant difference between the two groups in the TNFβ genotype and allele frequency （P〉0.05）. The time of mechanical ventilation was shorter and that of staying in the intesive care unit was longer for ARDS patients with the 1/2 genotype in the TNFβ than for these with other genotypes （both P〈 0.05）. The frequency of the 1/1 genotype and 1 allele in the TNFβ was significantly higher in the group of surviving patients with ARDS than in the group of death patients. The odd ratios for mortality of two groups were 16.5 and 11.2, respectively. Conclusions： TNFβ did not appear to be a contributing factor influencing the morbidity of the patients with ARDS after operation for esophageal carcinoma, however, it might affect the development and prognosis of ARDS.