介入治疗对肝细胞癌耐药基因表达的影响

The effect of different interventional treatment on P glycoprotein in different histopathological types of primary hepatocellular carcinoma

目的研究不同介入方法对不同组织学类型的原发性肝细胞癌（ｐｒｉｍａｒｙｈｅｐａｔｏｃｅｌｕｌａｒｃａｒｃｉｎｏｍａ，ＰＨＣ）多药耐药（ｍｕｔｉｄｒｕｇｒｅｓｉｓｔａｎｃｅＭＤＲ）基因表达蛋白（Ｐｇｌｙｃｏｐｒｏｔｅｉｎ，Ｐｇｐ）的影响。方法７种不同组织学类型的ＰＨＣ共９８例，单纯手术５７例，４种介入方法治疗后Ⅱ期切除４１例，采用链霉亲合素生物素酶复合物（ｓｔｒｅｐｔａｖｉｄｉｎｂｉｏｔｉｎｃｏｍｐｌｅｘ，ＳＡＢＣ）免疫组化方法，检测各标本中Ｐｇｐ的含量。结果Ｐｇｐ阳性百分数，介入Ａ、Ｂ、Ｃ、Ｄ各组和单纯手术组分别为１００．０％、６２．５％、４６．７％、１８．２％、５２．６％（各介入组与单纯手术组相比，χ２值分别为３．９６、０．０２、０．１７、４．３９，Ｐ值分别为＜０．０５、＝０．０２、＞０．５、＜０．０５）。透明细胞型、梁索型较低，实体型、未分化型较高。从Ⅰ级至Ⅳ级Ｐｇｐ表达有递增趋势。结论ＭＤＲ基因过度表达在ＰＨＣ天然性或获得性耐药起一定作用，且存在组织学差异。无水乙醇碘油乳化剂加明胶海绵联合栓塞可成为克服ＰＨＣ耐药的新途径。

Objective To study the effect of different interventional treatment on Pgp in different histopathological types of primary hepatocellular carcinoma (PHC). Methods Ninety eight histologically verified PHC specimens were studied. The patients were treated with surgical resection alone (57 cases), second stage surgical resection after four kinds of interventional treatment(41 cases). SABC immunohistochemical staining with a monoclonal antibody against human Pgp was used to observe the Pgp in all specimens. Results Pgp positive rate: 100.0% with chemotherapy alone, 62.5% with chemotherapy combined with iodized oil, 46.7% with chemotherapy combined with iodized oil and spongia gelatini absorbens (Sga), 18.2% with chemotherapy combined with Ethanol、iodized oil and Sga and 52.6% with surgical resection alone (all interventional group compared with surgical group. χ 2 value was 3.96、0.02、0.17、4.39, P value was <0.05、=0.02、>0.5、 <0.05 respetively). The positive rates of Pgp were different in different histopathologlcal types, the clear cell and trabecular PHC were the lowest, whereas the poorly differentiated or undifferentiated PHC was the highest. The positive rates of Pgp increased as pathological grade increased. Conclusions Overexpression of Pgp may be responsible for the intrinsic and acquired drug resistance of PHC. Histological differences exists in multidrug resistance(MDR). Therapy of PHC should be carried by individuation approach. Local chemotherapy combined with ethanol、 iodized oil and Sga embolization may become a new way to overcome MDR of PHC.