胆囊结石及癌变过程中肿瘤坏死因子的变化

Tumor necrosis factor-α in gallbladder and gallstone

目的 探讨肿瘤坏死因子(TNF-α)在胆囊结石及癌变过程中的变化。 方法 用放射免疫法对53例胆囊结石,9例胆囊癌血清及胆汁中TNF水平进行检测。 结果 血清及胆汁中TNF水平(ng/mL)胆囊癌组(1.35±0.28,10.28±3.23)较胆石症组(0.93±0.23,3.38±1.11)及对照组(0.67±0.17,2.12±0.55)均显著升高(P<0.01),胆囊粘膜从典型增生、非典型增生到胆囊癌的发展过程中TNF水平在血清(0.85±0.14,1.09±0.28,1.35±0.28)及胆汁中(3.04±0.93,4.05±1.17,10.28±3.23)逐级增高(各组间P<0.01),胆汁中TNF水平在胆囊癌Ⅰ～Ⅲ期(8.66±0.22)与Ⅳ～Ⅴ期(13.5±2.98)间差异显著(P<0.01),肿瘤直径≥2cm组(12.26±2.34)与≤2cm组(7.80±1.86)间差异显著(P<0.05),胆汁中TNF水平明显高于其对应的血清水平,两者之间呈正直线相关(r=0.68,P<0.001),胆囊癌术后血清TNF水平显著下降。 结论 TNF参与胆囊结石致癌的过程,与胆囊癌的临床生物学特点密切相关。

AIM To reveal the role of tumor necrosis factor-α (TNF-α) in the developing course of gallbladder carcinoma with gallstone, and measure the levels of TNF-α in plasma and bile.METHODS The level of TNF-α was detected by RIA in 9 patients with gallbladder carcinoma, 53 patients with gallstone and 11 normal subjects.RESULTS The levels(ng/mL) of TNF in plasma and bile of the cancer group (1.35±0.28, 10.28±3.23) were significantly higher than that of the gallstone (0.93±0.23, 3.38±1.11) and normal groups (0.67±0.17,2.12±0.55) (P<0.01). The levels of TNF in the plasma (0.85±0.14, 1.09±0.28,1.35±0.28) and bile (3.04± 0.93,4.05±1.17, 10.28±3.23) increased gradually in the course of the development of gallbladder mucosa from hyperplasia, dysplasia to carcinoma (P<0.001). The TNF levels in the bile of the Ⅳ-Ⅴ stages cancer group (13.5±2.98) was significantly higher than that of the Ⅰ-Ⅲ stages cancer group (8.66±0.22) (P<0.001). The TNF level in bile of the tumors above 2 cm (12.26±2.34) was markedly higher than that of tumors less 2 cm in size (7.80±1.86) (P< 0.05). Compared with the plasma, the TNF level in bile was much higher, (r = 0.68,P<0.001). The TNF level in plasma decreased greatly after operation. CONCLUSION TNF participated in the pathogenesis of gallbladder carcinoma induced by gallstone. The levels of TNF were correlated well with the clinical biology of the tumor.