胃癌证型与雌激素和孕激素受体蛋白表达的关系

Relationship between expressions of estrogen and progesterone receptors and syndrome types of gastric carcinoma

目的:探讨胃癌中医证型与雌激素受体(estrogen receptor,ER)及孕激素受体(progesterone receptor,PR)表达的关系。方法:72例胃癌患者术前按中医辨证分为6型,术后用免疫组织化学EnVision法检测胃癌组织ER与PR蛋白表达,观察不同证型预后因素与ER、PR蛋白表达的差异。结果:6种证型性别构成比较,差异有统计学意义(P<0.01),女性患者多见肝胃不和、胃热伤阴、气血双亏,而男性多见瘀毒内阻、痰湿凝结、脾胃虚寒。6种证型病理类型构成(P<0.01)、分化程度(P<0.05)、浸润深度(P<0.01)、淋巴结转移(P<0.05)、远处转移(P<0.05)、发生部位(P<0.01)、TNM分期(P<0.01)均不同。女性虚证比例较男性高,虚证恶性程度较高,虚实两证病变部位也不同。ER与PR的总阳性率分别为8.33%(6/72)和37.5%(27/72)。6种证型的PR表达差异有统计学意义(P<0.01),以胃热伤阴表达最高,瘀毒内阻表达最低,虚证表达高于实证表达(P<0.01)。6种证型间ER表达差异则无统计学意义。结论:胃癌各证型间存在PR表达差异,且与预后有关。PR可能是胃癌证型差异的物质基础之一。

Objective：To explore the relationship between expressions of estrogen （ER） and progesterone （PR） receptors and syndromes of traditional Chinese medicine （TCM） in gastric carcinoma and to establish prognostic indicators for gastric carcinoma.Methods：A total of 72 patients with gastric carcinoma were divided into six groups according to TCM syndrome differentiation.Specimens were collected after operation and ER and PR protein expressions were detected by EnVision immunohistochemical method.Results：The common syndromes in female patients with gastric carcinoma were disharmony between liver and stomach,yin impairment due to stomach heat,and insufficiency of both qi and blood;while in males,interior retention of stagnant toxin,interior retention of phlegm and dampness,and deficiency-cold in spleen and stomach were common.Different TCM syndromes were related with gender （P0.01）,pathology （P0.01）,cell differentiation （P0.05）,infiltration depth （P0.01）,lymphaden metastasis （P0.05）,distant metastasis （P0.05）,and TNM stage （P0.01）.Deficiency and excess syndromes were associated with gender （P0.05）,pathology （P0.05）,tumor location （P0.01） and TNM stage （P0.05）.The deficiency syndromes were common in female patients.The total positive rates of ER and PR expressions were 8.33% and 37.5% respectively.There was a significant difference in PR expression among different TCM syndromes （P0.01）.PR expression was significantly higher in the syndrome of yin deficiency due to stomach heat than in the other syndromes.The PR expressions in deficiency syndromes were significantly higher than those in excess syndromes （P0.01）.No correlation was found between ER expression and different TCM syndromes.Conclusion：There is a correlation between PR expression and different TCM syndromes in gastric carcinoma.