胃癌及术后随访患者血清血管生成素-2含量的临床意义

Clinical significance of serum angiopoietin-2 level in gastric cancer patients and the post-operational follow-up patients

目的检测胃癌及术后随访患者血清血管生成素-2（Ang-2）含量的变化，探讨其临床意义。方法采用ELISA法分别检测158例胃癌、31例慢性萎缩性胃炎、38例胃腺瘤息肉：28例慢性胃炎伴胃溃疡患者及30名健康对照者血清Ang-2与癌胚抗原（CEA）的含量，并检测131例行胃癌根治术患者术后2年血清Ang-2含量的变化，随访其预后。分析胃癌患者血清Ang-2含量与胃癌病理特征的关系。结果胃癌组血清Ang-2和CEA含量分别为（331．8±64．3）μg／L和（42．6±37．3）μg／L，较正常对照组[（187．4±32．7）μg／L和（4．2±3．1）μg／L]及胃溃疡组[（197．3±35．4）μg／L和（4．5±3．2）μg／L]显著升高（P值均〈0．01），慢性萎缩性胃炎组Ang-2含量亦明显升高（P〈0．05），而CEA含量无明显变化，胃腺瘤息肉组Ang-2与CEA含量均无明显变化。随访复发组及转移组术前血清Ang-2含量明显高于未复发组（P〈O．05）。未复发组术后1个月血清Ang-2含量降至正常范围，随访2年无明显升高。复发组术后1个月Ang-2含量亦降至正常范围，而术后6个月至2年显著高于未复发组及正常组（P〈0．01）。转移组术后2年Ang-2含量始终显著高于未复发组及正常组（P〈0．01）。未复发组2年存活率显著高于复发组和转移组。胃癌患者血清Ang-2含量变化与胃癌分化程度、TNM病理分期、有无淋巴结转移、有无远处组织转移、浸润深度和肿瘤大小均相关（P〈O．01），与组织学分型、肿瘤部位无相关性（P〉0．05）。结论血清Ang-2可作为一种新的具有一定临床价值的胃癌肿瘤标志物，有助于术后复发、转移的监测和预后评价。

Objective To study the difference and clinical significance of serum Angiopoietin-2 （Ang-2） level in gastric cancer, precancerous disease and the changes in post operation follow-up patients. Methods Serum Ang-2 and CEA levels were detected with ELISA method in 158 gastric cancer patients, 31 chronic astrophic gastritis patients, 38 gastric adenomatous polyp patients, 28 chronic gastritis patients with benign gastric ulcer and 30 healthy controls. The changes of serum Ang- 2 levels in 131 patients with radical gastrectomy were measured in 2-year post-operational followed-up and the prognosis was also evaluated. The correlation between serum Ang-2 level and the pathologic character of gastric cancer was analyzed. Results The serum Ang-2 and CEA levels of gastric cancer group were （331. 8±64. 3） μg/L and （42. 6±37. 3） μg/L, respectively, which were significantly higher than those of healthy control group [（187.4±32.7） μg/L and （4.24±3. 1） μg/L]and benign gastric ulcer group [（197.3±35.4）μg/L and （4.5±3.2） μg/L（all P〈0.01）. The serum Ang-2 level in chronic astrophic gastritis group was also markedly increased （P〈0.05）, however there was no significant change in CEA level. There was no obvious change of Ang 2 and CEA level in gastric adenomatous polyp group （P〈0.05）. Pre-operation serum Ang-2 levels of the relapse group and the metastasis group were significantly higher than that of no relapse group （P〈0.05）. Post-operation serum Ang-2 level of no relapse group decreased to normal range in 1 month and without obvious increase in 2 years follow-up. The serum Ang-2 level of the relapse group also decreased to normal range in 1 month post operation, while which was significantly higher than that of no relapse group and normal control group from 6 months to 2 years after operation （P〈0.01）. Serum Ang-2 level of the metastasis group was markedly higher than that of no relapse group and normal control group during 2 years after operation （P〈0.01）. The 2-year survival rate of no relapse group was significant higher than that of relapse group and metastasis group. The change of serum Ang-2 level was correlated with in the gastric cancer differentiation degree, TNM pathologic classification, lymphatic metastasis, distant metastasis, the depth of invasion and the tumor size （P〈0. 01）, however not correlated with histopathology type and the location of tumor. Conclusion Serum Ang-2 level may be a new and valuable gastric cancer marker, which will help to monitor tumor relapse, migration and prognosis assessment.